Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomo
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ORIGINAL ARTICLE
Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma Sampath Santhosh1,2 • Bhagwant Rai Mittal2 • Deepak Kumar Bhasin3 Surinder Singh Rana3 • Rajesh Gupta4 • Ashim Das5 • Ritambhra Nada5
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Received: 12 May 2017 / Accepted: 15 June 2017 Ó The Japanese Society of Nuclear Medicine 2017
Abstract Objective To evaluate the additional role of FDG-PET/CT to the conventional multiphasic CECT in the initial staging of pancreatic adenocarcinoma. Methods 54 patients diagnosed with pathologically proven pancreatic malignancy underwent FDG-PET/CECT. The sensitivity, specificity, PPV, NPV, and accuracy of PET/ CT and CECT for nodal and metastatic staging were calculated. The statistical difference was calculated by McNemar’s test. Results Of 54 patients, 15 had distal metastasis. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal staging were 33 vs 89%, 84 vs 100%, 67 vs 100%, 60 vs 90%, and 59 vs 95%, respectively, p \ 0.001. The sensitivity, specificity, PPV, NPV, and The work was done in the Postgraduate Institute of Medical Education and Research, Chandigarh. & Sampath Santhosh [email protected] 1
Present Address: Institute of Nuclear Imaging and Molecular Medicine, Tamil Nadu Government Multi Super Specialty Hospital, Omandurar Government Estate, Anna Salai, Chennai, Tamil Nadu 600002, India
2
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
3
Department of Medical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
4
Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
5
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
accuracy of CECT for metastatic staging were 73, 87, 69, 89, and 83%, whereas the accuracy of PET/CT was 100%, p = 0.01. By correctly characterizing unsuspected distant lesions, PET/CT could change management in 19% of patients. Conclusion FDG-PET/CT can contribute to change in the management in almost one of every five patients of PA evaluated with the standard investigations during the initial staging. Keywords FDG-PET/CECT Pancreatic adenocarcinoma Staging Metastasis Malignancy
Introduction Surgical resection is the only potentially curative technique for managing pancreatic adenocarcinoma (PA) [1]. However, more than 80% of patients present with disease that cannot be cured with surgical resection [2]. The imaging modalities used for diagnosis and staging of PA include transabdominal ultrasound, contrast-enhanced computed tomography, magnetic resonance imaging with cholangiopancreatography, endoscopic ultrasound/retrograde cholangiopancreatography, and positron emission tomography (PET) [3]. Only 70–85% of patients determined to
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