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The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Previous studies have suggested that whole body positron-emission tomography (PET) can distinguish between benign and malignant cysts of the pancreas. Patients were identified (n=68) who had undergone whole body PET imaging for a cystic lesion of the pancreas between Jan. 1997 and May 2005. Cross-sectional imaging studies were reviewed by a single blinded radiologist, and positive PET studies were reviewed by a blinded nuclear medicine physician. Operative resection was performed in 21 patients (31%), and 47 patients were managed with radiographic follow-up. F-18 Fluorodeoxyglucose (FDG)-avid lesions were identified in eight of the 68 patients (12%). Within the resected group of patients (n=21), four of the seven patients (57%) with either in situ or invasive malignancy (adenocarcinoma: 3 of 5, papillary mucinous carcinoma: 1 of 2) had positive PET imaging (mean SUV, 5.9; range 2.5-8.0), and 2 of the 14 patients (14%) with benign lesions had positive PET imaging (serous cystadenoma, n=1, SUV=3.3; pseudocyst n=1, SUV=2.7). All lesions proven to be malignant with increased FDG uptake had highly suspicious findings on cross-sectional imaging. Within the group of resected patients, the sensitivity of PET for identifying malignant pathology was 57%, and the specificity was 85%. The sensitivity and specificity of PET for malignancy in this study was lower than previously reported, and PET findings did not identify otherwise occult malignant cysts. We do not believe whole body FDG-PET to be essential in the evaluation of cystic lesions of the pancreas.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., 10021, New York, NY

    John C. Mansour M.D., Michael D’Angelica M.D., Yuman Fong M.D., Murray F. Brennan M.D. & Peter J. Allen M.D.

  2. Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

    Neeta Pandit-Taskar M.D. & Steven M. Larson M.D.

  3. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Lawrence Schwartz M.D., Neeta Pandit-Taskar M.D. & Steven M. Larson M.D.

Authors
  1. John C. Mansour M.D.
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  2. Lawrence Schwartz M.D.
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  3. Neeta Pandit-Taskar M.D.
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  4. Michael D’Angelica M.D.
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  5. Yuman Fong M.D.
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  6. Steven M. Larson M.D.
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  7. Murray F. Brennan M.D.
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  8. Peter J. Allen M.D.
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Correspondence to Peter J. Allen M.D..

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Mansour, J.C., Schwartz, L., Pandit-Taskar, N. et al. The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas. J Gastrointest Surg 10, 1354–1360 (2006). https://doi.org/10.1016/j.gassur.2006.08.002

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