PET/CT imaging in pancreatic cancer: A retrospective review

Objectives Pancreatic cancer is an aggressive disease, with dismal 5 year survival rates. Earlier diagnosis and staging is crucial to overall prognosis. We are presenting retrospective analysis of the role of PET/CT imaging in pancreatic cancer.

Methods Patients undergoing FDG PET/CT with pancreatic cancer during the period 1/2004 - 12/2007 are included in this study. A total of 201 studies (n=118) were performed (45 female; 73 male, Age 31-87). Diagnostic validation was obtained by tissue sampling and/or 3 month radiological follow up. The indications for referral and performance of PET/CT imaging was evaluated by chart review.

Results Restaging disease was the most common indication, 95 studies (n=44), with 52 studies were true positive (TP), 32 true negative (TN) and 4 false negative (FN) for detection of local disease. PET/CT correctly identified systemic disease in 54 studies(TP) with 24 TN studies in this group. The sensitivity and specificity were 93% and 86%, respectively in detecting local disease and 86% and 75%, respectively in detecting metastatic disease. 68 studies (n=44) were performed for treatment monitoring. PET/CT imaging was TP in 51 studies and TN in 10 studies in identifying local disease while accurately identified systemic disease in 36 studies (TP), with 23 TN studies. 28 studies (n=28) were performed for initial staging, with 27 TP in local disease and 15 TP in metastatic disease. Only 10 studies (n=10) were performed for diagnostic purposes.Adenoca was the most common malignancy (108/118).

Conclusions In this large retrospective experience, FDG PET/CT performed well for tumor restaging as well as treatment monitoring, which may have potentially significant management and prognostic implications.