Benefit of PET/CT in the Preoperative Staging in Pancreatic Carcinomas

Česká verzia

Authors: J. Kysučan; M. Loveček; Dušan Klos ; I. Tozzi ¹; P. Koranda ²; E. Buriánková ¹; Č. Neoral; R. Havlík
Authors place of work: I. chirurgická klinika FN a UP Olomouc, přednosta: doc. MUDr. Čestmír Neoral, CSc. ; II. interní klinika FN a UP Olomouc, přednosta: doc. MUDr. Vlastimil Procházka, Ph. D. ¹; Klinika nukleární medicíny FN a UP Olomouc, přednosta: doc. MUDr. Miroslav Mysliveček, Ph. D. ²
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 7, s. 433-440.
Category: Monothematic special - Original

Summary

Objective:
Prognosis of patients with pancreatic cancer is poor. Median survival from diagnosis without determining surgical treatment is 3–11 months, after surgical treatment between 13–20 months according to various studies. 5-year survival rate is below 5%. The only chance of cure remains a radical surgical resection. Early diagnosis and determining resectability of tumour is the most important objective in patients with pancreatic cancer. Aim of this work is to evaluate the benefits and define the role of 18F-FDG PET/CT in preoperative staging.

Material and Methods:
195 patients (103 men, 92 women, mean age 66.7 year, range 32–88 years) with suspected pancreatic lesions underwent enhanced 18F-FDG PET/CT in the preoperative staging in addition to standard investigative methods (ultrasonography, contrast enhanced CT, EUS, EUS FNA). All PET/CT findings were compared with standard methods (CT, EUS, EUS FNA), with peroperative findings and definitivě histology in surgical patients as the reference standards. Interpretation of the extent of the tumor defined by TNM classification. Limitations of the local resectability was advanced local stage (T4) and presence of distant metastases (M1).

Results:
In 195 patients with suspected pancreatic lesions was pre-operatively performed PET/CT in the period 1/2007-3/2009. 153 patients with pancreatic cancer, of which 72 was not suitable for radical surgery because of local inoperability or a generalization of the disease. The sensitivity of PET/CT in the capture of primary lesions was 92.2%, specificity 90.5%. False negative findings in 12 patients, false-positive results occurred in 4 cases, positive predictive value (PPV) 97.2%, negative predictive value (NPV) 76.0%. In the assessment of regional lymph nodes sensitivity was 51.9%, specificity 58.3%, PPV 58.3%, NPV 51.9%. In detection of distant metastases PET/CT reached sensitivity 82.8%, specificity 97.8%, PPV 96.9%, NPV 87.0%. PET/CT found distant metastases in 12 patients, which standard methods failed to detect. Surgery was cancelled in 15 patients (15.6%) with potentially resectable tumour based on the performance of PET/CT findings and the management of treatment was changed.

Conclusion:
PET/CT is highly sensitive and specific method suitable for preoperative staging of pancreatic cancer. It improves the selection of patients for surgery, who can benefit from and reduces the number of incorrectly indicated operations.

Key words:
pancreatic cancer – PET/CT – staging – resection

Zdroje

1. Cress, R. D., et al. Survival among patiens with adenocarcinoma of the pancreas, a population-based study (United States). Cancer Cause Control, 2006, 17, p. 403–409.

2. Imamura, M., et al. A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery, 2004.

3. Heinrich, S., Goerres, G. W., Schafer, M., et al. Positron Emission Tomography/Coniputed Tomography Influences on the Management of Resectable. 136, p. 1003–1011.

4. Adam, Z., Vorlíček, J., Vaníček, J., et al. Diagnostické a léčebné postupy u maligních chorob. Praha, Grada Publishing, 2002.

5. Strobel, K., Heinrich, S., Bhure, U., et al. Contrast-Enhanced 18F-FDG PET/CT: 1-Stop-Shop Imaging for Assessing the Resectability of Pancreatic Cancer., J Nucl Med 2008, 49 (9), p. 1408–1413.

6. Wray, C. J., Ahmad, S. A., Matthews, J. B., Lowy, A. M. Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterology, 2005; 128: 1626–1641.

7. Pancreatic Cancer and Its Cost Effectiveness. Ann. Surg., 2005, 242 (2), p. 235–243.

8. Antoch G., Saoudi N., Kuehl H., et al. Accuracy of Whole-Body Dual-Modality Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Tumor Staging in Solid Tumors: Comparison with CT and PET. J. Clin. One, 2004, 22 (21), p. 4357–4368.

9. Farma, J. M., Santillan, A. A., Melis, M., et al. PET/CT Fusion Scan Enhances CT Staging in Patients with Pancreatic Neoplazma. Ann. Surg. Oncol., 2008, 15(9), p. 2465–2471.

10. Nishivama, Y., Yamanoto, Y., Yokoe, K., et al. Contribution of Whole Body FDG-PET to the Detection of Distant Metastasis in Pancreatic Cancer. Ann. Nucl. Med., 2005, 19(6), p. 491–497.

11. Bar-Shalom, R., Yefremov, N., Guralnik, L., et al. Clinical Performance of PET/CT in Evaluation of Cancer: Additional Valu efor Diagnostic Imaging and Patient Management. J. Nucl. Med., 2003, 44(8), p. 1200–1209.

12. Hicks, R. J., Ware, R. E., Lau, E. W. PET/CT: Will It Change the Way That We Use CT in Cancer Imaging? Cancer Imaging, 2006, 31(6), p. 52–62.

13. Sloka, J. S., Hollet, P. D. Cost Effectiveness of Possitron Emission Tomography in Canada. Med. Sci. Monit., 2005, 11, p. 1–6.

14. Lemke, A. J., Niehues, S. M., Hosten, N., et al. Retrospective Digital Image Fusion of Multidetector CT and 18F-FDG PET: Clinical value in Pancreatic Lesions- A Prospective Study with 104 Patients. J. Nucl. Med., 2004, 45, 1279–1286.

15. Schick, V., Franzius, Ch., Beyna, T., et al. Diagnostic Impact of 18F-FDG PET-CT Evaluating Solid Pancreatic Lesions vs Endosonography, Endoscopic Retrograde Cholangio-panereatography with Intraductal Ultrasonography and Abdominal Ultrasound. Eur. J. Nucl. Med. Mol. Imaging, 2008, 35, p. 1775–1785.

16. Pakzad, F., Groves, A. M., Eli, P. J. The Role of Positron Emisson Tomography in the Management of Pancreatic Cancer. Semin. Nucl. Med., 2006, 36(3), p. 248–256.

17. Quon, A., Chang, S. T., Chin, F., et al. Initial evaluation of 18F-fluorothymidine (FLT) PET/CT scanning for primary pancreatic cancer. Eur. J. Nucl. Med. Mol. Imaging, 2008; 35: 527–531.

18. Ambrosini, V., Tomassetti, P., Castellucci, P., et al. Comparison between 68Ga-DOTA-NOC and 18F-DOPA PET for the detection of gastro-entero-panereatic and lung neuro-endoerine tumours. Eur. J. Nucl. Med. Mol. Imaging, April 17, 2008 [Epub ahead of print].

19. Israel, O., Mor, M., Guralnik, L., et al. Is 18F-FDG PET/CT Useful for Imaging and Management of Patients with Suspected Occult Recurrence of Cancer? J. Nucl. Med., 2004, 45, p. 2045–2051.

20. Klos, D., Havlík, R., Loveček, M., Srovnal, J., Kesselová, M., Radová, L., Hajduch, M., Neoral, Č.: Klinický význam stanovení minimální reziduální choroby u karcinomu pankreatu – pilotní studie. Miniinvazivna chir. a endoskop., 2009, 4, 5–10.