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

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Journal of Gastrointestinal Surgery



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.


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


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.


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.

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  1. Brennan DD, Zamboni GA, Raptopoulos VD et al. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics 2007;27:1653–1666

    Article  PubMed  Google Scholar 

  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;27:2269–2277

    Article  CAS  PubMed  Google Scholar 

  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;297:267–277

    Article  CAS  PubMed  Google Scholar 

  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;207:490–498

    Article  PubMed  Google Scholar 

  5. Fischer B, Lassen U, Mortensen J, et al. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 2009;361:32–39

    Article  CAS  PubMed  Google Scholar 

  6. Seam P, Juweid ME, Cheson BD. The role of FDG-PET scans in patients with lymphoma. Blood 2007;110:3507–3516

    Article  CAS  PubMed  Google Scholar 

  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;4:1678–1683

    Article  Google Scholar 

  8. Annovazzi A, Peeters M, Maenhout A, et al. 18-fluorodeoxyglucose positron emission tomography in nonendocrine neoplastic disorders of the gastrointestinal tract. Gastroenterology 2003;125:1235–1245

    Article  PubMed  Google Scholar 

  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;242:235–243

    Article  PubMed  Google Scholar 

  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;40:1784–1791

    CAS  PubMed  Google Scholar 

  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;17:173–178

    PubMed  Google Scholar 

  12. Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–1379

    CAS  PubMed  Google Scholar 

  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;17:261–279

    Article  PubMed  Google Scholar 

  14. Fortner JG, Klimstra DS, Senie RT, et al. Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy. Ann Surg 1996;223:147–153

    Article  CAS  PubMed  Google Scholar 

  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;104:1066–1074

    Article  PubMed  Google Scholar 

  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;285:914–924

    Article  CAS  PubMed  Google Scholar 

  17. Frohlich A, Diederichs CG, Staib L. Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 1999;40:250–255

    CAS  PubMed  Google Scholar 

  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;22:379–385

    Article  PubMed  Google Scholar 

  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 2004:18:637–640

    Article  CAS  PubMed  Google Scholar 

  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;16:2113–2125

    CAS  PubMed  Google Scholar 

  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;20:1543–1547

    Article  CAS  PubMed  Google Scholar 

  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;27:52

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Parsons CM, Sutcliffe JL, Bold RJ. Preoperative evaluation of pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg 2008;15:429–435

    Article  PubMed  Google Scholar 

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The authors declare no conflict of interest and no financial arrangement with any company.

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Correspondence to Kunihiko Izuishi.

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Izuishi, K., Yamamoto, Y., Sano, T. et al. Impact of 18-Fluorodeoxyglucose Positron Emission Tomography on the Management of Pancreatic Cancer. J Gastrointest Surg 14, 1151–1158 (2010).

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