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Annals of Surgical Oncology 9:799-806 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Clinical Utility of Positron Emission Tomography in the Diagnosis and Management of Periampullary Neoplasms

Matthew F. Kalady, MD, Bryan M. Clary, MD, Lisa A. Clark, MD, Marcia Gottfried, MD, Eric M. Rohren, MD, R. Edward Coleman, MD, Theodore N. Pappas, MD and Douglas S. Tyler, MD

From the Departments of Surgery (MFK, BMC, LAC, TNP, DST), Pathology (MG), and Radiology (EMR, EC), Duke University Medical Center, Durham, North Carolina.

Correspondence: Address correspondence and reprint requests to: Douglas S. Tyler, MD, Duke University Medical Center, Box 3118, Durham, NC 27710; Fax: 919-681-8701; E-mail: tyler002{at}acpub.duke.edu

Background: This study examined the effect that 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) imaging had on the clinical management of patients with suspected periampullary malignancy.

Methods: Fifty-four patients with suspected pancreatic neoplasms underwent both whole-body 18FDG-PET and abdominal computed tomography (CT). Malignant or benign disease was confirmed pathologically in 47 patients.

Results: Of the 41 patients with malignancy, 18FDG-PET failed to identify the primary tumor in 5 patients. 18FDG-PET demonstrated increased uptake suggesting primary malignancy in 37 patients. Malignant pathology was confirmed in 36 cases. 18FDG-PET identified malignant locoregional lymph node metastases in six of ten patients. All nodes identified before surgery by 18FDG-PET were also seen on preoperative CT. Six patients who were thought to have resectable disease by CT were found to have distant metastasis at laparotomy. 18FDG-PET did not detect metastasis in any of these cases. Before surgery, 18FDG-PET identified distant metastases that were not detected by CT in one patient.

Conclusions: Despite high sensitivity and specificity in diagnosing periampullary malignancy, 18FDG-PET did not change clinical management in the vast majority of patients previously evaluated by CT. In addition, 18FDG-PET missed >10% of periampullary malignancies and did not provide the anatomical detail necessary to define unresectabilty.

Key Words: Pancreatic cancer • Positron emission tomography • Computed tomography • Diagnostic imaging • Periampullary cancer




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 RadiologyHome page
E. M. Rohren, T. G. Turkington, and R. E. Coleman
Clinical Applications of PET in Oncology
Radiology, May 1, 2004; 231(2): 305 - 332.
[Abstract] [Full Text] [PDF]


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