Journal of Gastrointestinal Surgery

, Volume 14, Issue 7, pp 1151–1158

Impact of 18-Fluorodeoxyglucose Positron Emission Tomography on the Management of Pancreatic Cancer

  • Kunihiko Izuishi
  • Yuka Yamamoto
  • Takanori Sano
  • Ryusuke Takebayashi
  • Tsutomu Masaki
  • Yasuyuki Suzuki
Original Article

Abstract

Background

We compared the usefulness of positron emission tomography with the glucose analogue 2-deoxy-2-[18F]-fluoro-d-glucose (FDG-PET) and multidetector-row computed tomography (MD-CT) in diagnosing pancreatic cancer and in determining the patients’ suitability for surgery.

Methods

We reviewed the clinical FDG-PET data of 103 consecutive pancreatic cancer patients between July 2004 and March 2009.

Results

The detection rates of pancreatic cancer by MD-CT (89%) and FDG-PET (91%) were similar. From the MD-CT findings, 38 patients were judged as operable, and 65, inoperable. Among the inoperable patients, noncurative factors (metastasis to the liver, peritoneum, remote lymph nodes, bones, and other organs and major arterial invasion) were detected by MD-CT and/or FDG-PET. Detection rates of liver metastasis and arterial invasion by FDG-PET were significantly inferior to those of MD-CT (neither was detected by FDG-PET alone). Remote lymph nodes and bone metastasis were detected in 20 lesions by FDG-PET alone; however, MD-CT indicated other noncurative factors in these patients. All 65 patients could be diagnosed as inoperable without FDG-PET.

Conclusions

FDG-PET is not a suitable imaging modality for either diagnosis or preoperative treatment in pancreatic cancer patients. Since it is expensive, FDG-PET as a routine diagnostic tool in pancreatic cancer patients must be used with caution.

Keywords

18-Fluorodeoxyglucose Positron emission tomography Pancreatic cancer Multidetector-row computed tomography 

References

  1. 1.
    Brennan DD, Zamboni GA, Raptopoulos VD et al. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics 2007;27:1653–1666CrossRefPubMedGoogle Scholar
  2. 2.
    Huguet F, Girard N, Guerche CS, et al. Chemoradiotherapy in the management of locally advanced pancreatic carcinoma: a qualitative systematic review. J Clin Oncol 2009;27:2269–2277CrossRefPubMedGoogle Scholar
  3. 3.
    Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007;297:267–277CrossRefPubMedGoogle Scholar
  4. 4.
    Vin Y, Sima CS, Getrajdman GI, et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008;207:490–498CrossRefPubMedGoogle Scholar
  5. 5.
    Fischer B, Lassen U, Mortensen J, et al. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 2009;361:32–39CrossRefPubMedGoogle Scholar
  6. 6.
    Seam P, Juweid ME, Cheson BD. The role of FDG-PET scans in patients with lymphoma. Blood 2007;110:3507–3516CrossRefPubMedGoogle Scholar
  7. 7.
    Zafra M, Ayala F, Gonzalez-Billalabeitia E, et al. Impact of whole-body 18F-FDG PET on diagnostic and therapeutic management of Medical Oncology patients. Eur J Cancer 2008;4:1678–1683CrossRefGoogle Scholar
  8. 8.
    Annovazzi A, Peeters M, Maenhout A, et al. 18-fluorodeoxyglucose positron emission tomography in nonendocrine neoplastic disorders of the gastrointestinal tract. Gastroenterology 2003;125:1235–1245CrossRefPubMedGoogle Scholar
  9. 9.
    Heinrich S, Goerres GW, Schäfer M et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005;242:235–243CrossRefPubMedGoogle Scholar
  10. 10.
    Delbeke D, Rose DM, Chapman WC, et al. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 1999;40:1784–1791PubMedGoogle Scholar
  11. 11.
    Saif MW, Cornfeld D, Modarresifar H, et al. 18F-FDG positron emission tomography CT (FDG PET-CT) in the management of pancreatic cancer: initial experience in 12 patients. J Gastrointestin Liver Dis 2008;17:173–178PubMedGoogle Scholar
  12. 12.
    Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–1379PubMedGoogle Scholar
  13. 13.
    Higashi T, Saga T, Nakamoto Y, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET)—usefulness and limitations in "clinical reality." Ann Nucl Med 2003;17:261–279CrossRefPubMedGoogle Scholar
  14. 14.
    Fortner JG, Klimstra DS, Senie RT, et al. Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy. Ann Surg 1996;223:147–153CrossRefPubMedGoogle Scholar
  15. 15.
    Isasi CR, Lu P, Blaufox MD. A metaanalysis of 18F-2-deoxy-2-fluoro-d-glucose positron emission tomography in the staging and restaging of patients with lymphoma. Cancer 2005;104:1066–1074CrossRefPubMedGoogle Scholar
  16. 16.
    Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285:914–924CrossRefPubMedGoogle Scholar
  17. 17.
    Frohlich A, Diederichs CG, Staib L. Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 1999;40:250–255PubMedGoogle Scholar
  18. 18.
    Terauchi T, Murano T, Daisaki H, et al. Evaluation of whole-body cancer screening using 18F-2-deoxy-2-fluoro-d-glucose positron emission tomography: a preliminary report. Ann Nucl Med 2008;22:379–385CrossRefPubMedGoogle Scholar
  19. 19.
    Yamamoto F, Nakada K, Zhao S, et al. Gastrointestinal uptake of FDG after N-butylscopolamine or omeprazole treatment in the rat. Ann Nucl Med 2004:18:637–640CrossRefPubMedGoogle Scholar
  20. 20.
    Gambhir SS, Shepherd JE, Shah BD, et al. Analytical decision model for the cost-effectiveness management of solitary pulmonary nodules. J Clin Oncol 1998;16:2113–2125PubMedGoogle Scholar
  21. 21.
    Ngeow JY, Quek RH, Ng DC, et al. High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma. Ann Oncol 2009;20:1543–1547CrossRefPubMedGoogle Scholar
  22. 22.
    Miele E, Spinelli GP, Tomao F, et al. Positron emission tomography (PET) radiotracers in oncology—utility of 18F-fluoro-deoxy-glucose (FDG)-PET in the management of patients with non-small-cell lung cancer (NSCLC). J Exp Clin Cancer Res 2008;27:52CrossRefPubMedGoogle Scholar
  23. 23.
    Bang S, Chung HW, Park SW, et al. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol. 2006;40:923–929.CrossRefPubMedGoogle Scholar
  24. 24.
    Parsons CM, Sutcliffe JL, Bold RJ. Preoperative evaluation of pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg 2008;15:429–435CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Kunihiko Izuishi
    • 1
  • Yuka Yamamoto
    • 2
  • Takanori Sano
    • 1
  • Ryusuke Takebayashi
    • 1
  • Tsutomu Masaki
    • 3
  • Yasuyuki Suzuki
    • 1
  1. 1.Department of Gastroenterological Surgery, Faculty of MedicineKagawa UniversityKitaJapan
  2. 2.Department of Radiology, Faculty of MedicineKagawa UniversityKitaJapan
  3. 3.Department of Internal Medicine of Gastroenterology and Neurology, Faculty of MedicineKagawa UniversityKitaJapan

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