18-FDG PET in differentiating malignant from benign pancreatic cysts: a prospective study

Abstract The differential diagnosis between benign and malignant pancreatic cystic lesions may be very difficult. We recently found that F-18-fluorodeoxyglucose positron emission tomography (18-FDG PET) was useful for the preoperative work-up of pancreatic cystic lesions. This study was undertaken to confirm these results. From February 2000 to July 2003, 50 patients with a pancreatic cystic lesion were prospectively investigated with 18-FDG PET in addition to helical computed tomography (CT) and, in some instances, magnetic resonance imaging (MRI). The validation of diagnosis was based on pathologic findings after surgery (n=31), percutaneous biopsy (n=4), and according to follow-up in 15 patients. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The accuracy of FDG PET and CT was determined for preoperative diagnosis of malignant cystic lesions. Seventeen patients had malignant cystic lesions. Sixteen (94%) showed increased 18-FDG uptake (SUV>2.5), including two patients with carcinoma in situ. Eleven patients (65%) were correctly identified as having malignancy by CT. Thirty-three patients had benign tumors: two patients showed increased 18-FDG uptake, and four patients showed CT findings of malignancy. Sensitivity, specificity, positive and negative predictive value, and accuracy of 18-FDG PET and CT in detecting malignant tumors were 94%, 94%, 89%, 97%, and 94% and 65%, 88%, 73%, 83%, and 80%, respectively. 18-FDG PET is accurate in identifying malignant pancreatic cystic lesions and should be used in combination with CT in the preoperative evaluation of patients with pancreatic cystic lesions. A negative result with 18-FDG PET may avoid unnecessary operation in asymptomatic or high-risk patients

18-Florodeoxyglucose positron emission tomography in predicting survival of patients with pancreatica carcinoma

The prediction of survival of patients with pancreatic cancer is usually based on tumor staging and grading and on the level of tumor markers. However, accurate tumor staging can be obtained only after resection, and still there is a great difference in survival rates among patients with the same clinicopathologic parameters. Recently the uptake of 18-fluorodeoxyglucose (FDG) by positron emission tomography (PET) has been found to be correlated with survival in patients with pancreatic cancer. This study evaluated the role of 18FDG PET as a prognostic factor for patients with pancreatic cancer. From June 1996 to July 2002, a total of 118 patients underwent PET for pancreatic cancer. The standardized uptake value (SUV) of 18FDG was calculated in 60 of them, and these patients were divided into high (>4) and low (< or =4) SUV groups. They were also evaluated according to the tumor node metastasis (TNM) classification system of the International Union Against Cancer, and by tumor grade, medical or surgical treatment, diabetes, age, sex, and CA 19-9 serum levels. Twenty-nine cancers showed high and 31 showed low SUVs. Survival was significantly influenced by tumor stage (P=0.0001), tumor grade (P=0.01), and SUV (P=0.005). Multivariate analysis showed that only stage (P=0.001) and SUV (P=0.0002) were independent predictors of survival. When patients who were analyzed for SUV were stratified according to the other variables, FDG uptake was related to survival also after stratification for the following: stage III to IVa (P=0.002), stage IVb (P=0.01), tumor resection (P=0.006), moderately differentiated tumors (P=0.01), age less than 65 years (P=0.006), CA 19-9 levels greater than 300 kU/L (P=0.002), and absence of diabetes (P=0.0001). The SUV calculated with 18FDG PET is an important prognostic factor for patients with pancreatic cancer and may be useful in selecting patients for therapeutic management

Adenocarcinoma of the pancreas: the rationale for neoadjuvant therapy

The survival of patients with pancreatic cancer is dismal: tumor's resection is possible in only 10-20% of patients. This has prompted clinical studies with chemotherapy and/or radiotherapy designed to increase the number of patients eligible for surgery, to maximize local tumor control and to improve the length of survival. Since postoperative chemoradiation is often delayed in these patients due to morbidity and prolonged recovery time associated with surgery, investigators are assessing the efficacy of chemoradiation before pancreatic resection in patients with potentially resectable pancreatic carcinoma or the potential to downstage locally advanced pancreatic cancer to resectable tumor. The analysis of several clinical trials published so far shows that results are conflicting and not definitive. No randomized clinical studies have been reported. Moreover, neoadjuvant therapy rarely leads to surgical downstaging allowing for potentially curative pancreatic resections. Novel multimodality approaches are required, and patients should be entered on clinical, controlled trials