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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jan 7, 2008; 14(1): 64-69
Published online Jan 7, 2008. doi: 10.3748/wjg.14.64
Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer
Hisao Wakabayashi, Yoshihiro Nishiyama, Tsuyoshi Otani, Takanori Sano, Shinichi Yachida, Keiichi Okano, Kunihiko Izuishi, Yasuyuki Suzuki
Hisao Wakabayashi, Tsuyoshi Otani, Takanori Sano, Shinichi Yachida, Keiichi Okano, Kunihiko Izuishi, Yasuyuki Suzuki, Department of Gastroenterological Surgery, Kagawa University, Kagawa 761-0793, Japan
Yoshihiro Nishiyama, Department of Radiology, Kagawa University, Kagawa 761-0793, Japan
Correspondence to: Hisao Wakabayashi, MD, Department of Gastroenterological Surgery, Kagawa University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. hisao-w@med.kagawa-u.ac.jp
Telephone: +81-87-8912438
Fax: +81-87-8912439
Received: June 29, 2007
Revised: September 17, 2007
Published online: January 7, 2008
Abstract

AIM: To evaluate the role of positron emission tomo-graphy using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment.

METHODS: This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer.

RESULTS: The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.

CONCLUSION: FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.

Keywords: Pancreatic cancer; Fluorodeoxyglucose positron emission tomography; Computed tomography; Standard uptake value; Carcinoembrionic antigens; Carbohydrate antigen 19-9; Prognostic factor