Strobel Klaus, Heinrich Stefan, Bhure Ujwal, Soyka Jan, Veit-Haibach Patrick, Pestalozzi Bernhard C, Clavien Pierre-Alain, Hany Thomas F
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland.
J Nucl Med. 2008 Sep;49(9):1408-13. doi: 10.2967/jnumed.108.051466. Epub 2008 Aug 14.
Patients with pancreatic cancer continue to have a poor prognosis, with a 5-y survival rate of less than 5%. Surgery is the only treatment that offers a potential cure. Determining resectability is the principal goal of staging in pancreatic cancer patients. Our objective was to evaluate the value of combined contrast-enhanced (18)F-FDG PET/CT in assessing the resectability of pancreatic cancer and to compare enhanced PET/CT with the performance of PET alone and unenhanced PET/CT.
Fifty patients (25 women and 25 men; mean age, 64.3 y; range, 39-84 y) with biopsy-proven pancreatic adenocarcinoma underwent enhanced (18)F-FDG PET/CT for the evaluation of resectability. Criteria for unresectability were distant metastases, peritoneal carcinomatosis, arterial infiltration, or invasion of neighboring organs other than the duodenum. The performance of enhanced PET/CT regarding resectability was compared with that of PET alone and unenhanced PET/CT. Histology, intraoperative findings, and follow-up CT with clinical investigations were used as the reference standard.
According to the reference standard, 27 patients had disease that was not resectable because of distant metastases (n=17), peritoneal carcinomatosis (n=5), or local infiltration (n=5). In the assessment of resectability, PET alone had a sensitivity of 100%, specificity of 44%, accuracy of 70%, positive predictive value of 61%, and negative predictive value of 100%; unenhanced PET/CT had respective values of 100%, 56%, 76%, 66%, and 100%; and enhanced PET/CT, 96%, 82%, 88%, 82%, and 96%. In 5 patients, unresectability was missed by all imaging methods and was diagnosed intraoperatively. Enhanced PET/CT was significantly superior to PET alone (P=0.035), and there was a trend for enhanced PET/CT to be superior to unenhanced PET/CT (P=0.070).
The use of enhanced PET/CT as a 1-stop-shop imaging protocol for assessing the resectability of pancreatic cancer is feasible and accurate. Enhanced PET/CT is significantly superior to PET alone.
胰腺癌患者的预后仍然很差，5年生存率低于5%。手术是唯一有可能治愈的治疗方法。确定可切除性是胰腺癌患者分期的主要目标。我们的目的是评估联合增强（18）F-FDG PET/CT在评估胰腺癌可切除性方面的价值，并将增强PET/CT与单独PET以及未增强PET/CT的性能进行比较。
50例经活检证实为胰腺腺癌的患者（25名女性和25名男性；平均年龄64.3岁；范围39-84岁）接受增强（18）F-FDG PET/CT以评估可切除性。不可切除的标准为远处转移、腹膜癌转移、动脉浸润或除十二指肠外侵犯邻近器官。将增强PET/CT在可切除性方面的表现与单独PET以及未增强PET/CT的表现进行比较。组织学、术中发现以及随访CT和临床检查用作参考标准。
根据参考标准，27例患者因远处转移（n=17）、腹膜癌转移（n=5）或局部浸润（n=5）而患有不可切除的疾病。在评估可切除性方面，单独PET的敏感性为100%，特异性为44%，准确性为70%，阳性预测值为61%，阴性预测值为100%；未增强PET/CT的相应值分别为100%、56%、76%、66%和100%；增强PET/CT的相应值分别为96%、82%、88%、82%和96%。5例患者的不可切除性被所有成像方法漏诊，术中确诊。增强PET/CT明显优于单独PET（P=0.035），并且增强PET/CT有优于未增强PET/CT的趋势（P=0.070）。
使用增强PET/CT作为一站式成像方案来评估胰腺癌的可切除性是可行且准确 的。增强PET/CT明显优于单独PET。
