18F-FDG positron emission tomography CT (FDG PET-CT) in the management of pancreatic cancer: initial experience in 12 patients.

INTRODUCTION: Staging and restaging of pancreatic malignancy can be demanding. Often, there are liver lesions seen on diagnostic CT suspicious for secondary deposits. Positron emission tomography (PET)-CT may have a great potential in confirming or ruling out actual malignancy in those areas.

METHODS: We prospectively studied 12 pancreatic adenocarcinoma patients, who had undergone PET-CT imaging as part of their staging or restaging process. Imaging was performed after intravenous administration of 10 mCi F-18 FDG. Results were compared with CT, histopathological findings and/or clinical follow up.

RESULTS: PET-CT correctly identified 11 lesions and ruled the absence of disease in 4 out of 4 patients (PPV 92%, NPV of 100%, and accuracy 94%), compared to CT which had (PPV 79%, NPV 50% and accuracy 75%). CT identified 4 metastatic liver lesions in 12 patients of which 3 were actually benign processes.

CONCLUSION: FDG-PET detects pancreatic malignancy and metastatic disease with higher accuracy than conventional CT. The ability of PET-CT to rule out or correctly identify metastases greatly enhances the physician's decision-making process to choose the right therapeutic intervention.