Skip to main content
SpringerLink
Log in

Clinical role of fludeoxyglucose (18F) positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with pancreatic neuroendocrine tumors

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purposes

Clinical predictive markers for the malignant potential of pancreatic neuroendocrine tumors (PNETs) are limited without histological investigation. We reported previously that a loss of the regular enhancement pattern in preoperative computed tomography (CT) was correlated with the malignant tumor phenotype. This study aimed to establish whether the metabolic aspect of the tumor evaluated by fludeoxyglucose (18F) positron emission tomography/computed tomography 18F-FDG PET/CT is associated with the tumor imaging characteristics and postoperative oncological outcome.

Methods

Among 77 patients who underwent surgery with curative intent for a PNET at our institution between 2001 and 2017, 24 who received 18F-FDG PET/CT before surgery were enrolled in this study. The clinical importance of the standardized uptake value (SUVmax) was investigated with regard to tumor progression and prognosis after curative surgery.

Results

There were four (16%) patients with insulinoma. The mean tumor size was 17 mm and when the median value of the SUVmax (= 2.0) was measured as the cut-off value, the SUVmax ≥ 2.0 group (n = 12) was associated with large tumor size (p = 0.021), high tumor grade (p = 0.015), and irregular pattern on CT (p = 0.0055). The SUVmax was not correlated with age, gender, whether the tumor was functioning or non-functioning, or lymph node metastasis. The SUVmax ≥ 2.0 group had significantly poorer disease-free survival (median, 3.5 vs 16.2 months; p = 0.023) and poorer overall survival (median, 8.8 vs 16.2 months; p = 0.042).

Conclusion

An SUVmax ≥ 2.0 on 18F-FDG PET/CT might be associated with higher malignant potential of PNETs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hill JS, McPhee JT, McDade TP, Zhou Z, Sullivan ME, Whalen GF, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115:741–51.

    Article  Google Scholar 

  2. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72.

    Article  Google Scholar 

  3. Fitzgerald TL, Hickner ZJ, Schmitz M, Kort EJ. Changing incidence of pancreatic neoplasms: a 16-year review of statewide tumor registry. Pancreas. 2008;37:134–8.

    Article  Google Scholar 

  4. Keutgen XM, Nilubol N, Kebebew E. Malignant-functioning neuroendocrine tumors of the pancreas: A survival analysis. Surgery. 2016;159:1382–9.

    Article  Google Scholar 

  5. Madeira I, Terris B, Voss M, Denys A, Sauvanet A, Flejou JF, et al. Prognostic factors in patients with endocrine tumours of the duodenopancreatic area. Gut. 1998;43:422–7.

    Article  CAS  Google Scholar 

  6. Ekeblad S, Skogseid B, Dunder K, Oberg K, Eriksson B. Prognostic factors and survival in 324 patients with pancreatic endocrine tumor treated at a single institution. Clin Cancer Res. 2008;14:7798–803.

    Article  CAS  Google Scholar 

  7. Delbeke D, Martin WH. Positron emission tomography imaging in oncology. Radiol Clin North Am. 2001;39:883–917.

    Article  CAS  Google Scholar 

  8. Hustinx R, Benard F, Alavi A. Whole-body FDG-PET imaging in the management of patients with cancer. Semin Nucl Med. 2002;32:35–46.

    Article  Google Scholar 

  9. Kwon W, Howard BA, Herndon JE, Patz EF. FDG uptake on positron emission tomography correlates with survival and time to recurrence in patients with stage i non-small-cell lung cancer. J Thorac Oncol. 2015;10:897–902.

    Article  Google Scholar 

  10. Engelmann BE, Loft A, Kjaer A, Nielsen HJ, Gerds TA, Benzon EV, et al. Positron emission tomography/computed tomography and biomarkers for early treatment response evaluation in metastatic colon cancer. Oncologist. 2014;19:164–72.

    Article  CAS  Google Scholar 

  11. Shim JR, Lee SD, Han SS, Lee SJ, Lee DE, Kim SK, et al. Prognostic significance of (18)F-FDG PET/CT in patients with colorectal cancer liver metastases after hepatectomy. Europ J Surg Oncol. 2018;44:670–6.

    Article  Google Scholar 

  12. Chung HW, Lee EJ, Cho YH, Yoon SY, So Y, Kim SY, et al. High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma. J Cancer Res Clin Oncol. 2010;136:1929–35.

    Article  Google Scholar 

  13. Song BI, Kim HW, Won KS, Ryu SW, Sohn SS, Kang YN. Preoperative standardized uptake value of metastatic lymph nodes measured by 18F-FDG PET/CT improves the prediction of prognosis in gastric cancer. Medicine. 2015;94:e1037.

    Article  Google Scholar 

  14. Okabe H, Hashimoto D, Chikamoto A, Yoshida M, Taki K, Arima K, et al. Shape and enhancement characteristics of pancreatic neuroendocrine tumor on preoperative contrast-enhanced computed tomography may be prognostic indicators. Ann Surg Oncol. 2017;24:1399–405.

    Article  Google Scholar 

  15. Kim HS, Choi JY, Choi DW, Lim HY, Lee JH, Hong SP, et al. Prognostic value of volume-based metabolic parameters measured by (18)F-FDG PET/CT of pancreatic neuroendocrine tumors. Nucl Med Mol Imaging. 2014;48:180–6.

    Article  CAS  Google Scholar 

  16. Masui T, Doi R, Ito T, Kami K, Ogawa K, Harada D, et al. Diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography for pancreatic neuroendocrine tumors with reference to the World Health Organization classification. Oncol Letters. 2010;1:155–9.

    Article  Google Scholar 

  17. Farrell JM, Pang JC, Kim GE, Tabatabai ZL. Pancreatic neuroendocrine tumors: accurate grading with Ki-67 index on fine-needle aspiration specimens using the WHO 2010/ENETS criteria. Cancer Cytopathol. 2014;122:770–8.

    Article  Google Scholar 

  18. Sawayama H, Ishimoto T, Sugihara H, Miyanari N, Miyamoto Y, Baba Y, et al. Clinical impact of the Warburg effect in gastrointestinal cancer (review). Int J Oncol. 2014;45:1345–54.

    Article  CAS  Google Scholar 

  19. Scarpa A, Chang DK, Nones K, Corbo V, Patch AM, Bailey P, et al. Whole-genome landscape of pancreatic neuroendocrine tumours. Nature. 2017;543:65–71.

    Article  CAS  Google Scholar 

  20. Sadanandam A, Wullschleger S, Lyssiotis CA, Grotzinger C, Barbi S, Bersani S, et al. A cross-species analysis in pancreatic neuroendocrine tumors reveals molecular subtypes with distinctive clinical, metastatic, developmental, and metabolic characteristics. Cancer Disc. 2015;5:1296–313.

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan

    Takashi Matsumoto, Hirohisa Okabe, Yo-ichi Yamashita, Toshihiko Yusa, Rumi Itoyama, Yosuke Nakao, Takanobu Yamao, Naoki Umzaki, Masayo Tsukamoto, Yuki Kitano, Tatsunori Miyata, Kota Arima, Hidetoshi Nitta, Hiromitsu Hayashi, Katsunori Imai, Akira Chikamoto & Hideo Baba

Authors
  1. Takashi Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirohisa Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yo-ichi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshihiko Yusa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rumi Itoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yosuke Nakao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takanobu Yamao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naoki Umzaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masayo Tsukamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuki Kitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tatsunori Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kota Arima
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hidetoshi Nitta
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiromitsu Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Katsunori Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Akira Chikamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Hideo Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirohisa Okabe.

Ethics declarations

Conflict of interest

Takashi Matsumoto and his co-authors have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, T., Okabe, H., Yamashita, Yi. et al. Clinical role of fludeoxyglucose (18F) positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with pancreatic neuroendocrine tumors. Surg Today 49, 21–26 (2019). https://doi.org/10.1007/s00595-018-1703-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1703-2

Keywords

Search

Navigation