Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
Ann Surg Oncol. 2012 Oct;19(11):3574-80. doi: 10.1245/s10434-012-2234-5. Epub 2012 Jul 3.
Malignancy in intraductal papillary mucinous neoplasms (IPMN) of the pancreas may be predicted on the basis of a number of clinical and radiologic features, which have raised sensitivity but result in a specificity as low as 20-50%. We sought to confirm the additional value of (18)F-18-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) in diagnostic accuracy of imaging-based IPMN malignancy assessment.
This prospective uncontrolled case series contained 44 patients with IPMN undergoing comprehensive diagnostic evaluation, including magnetic resonance cholangiopancreatography and (18)FDG-PET. Average follow-up time was 39.3 months (range 3-97 months). Diagnostic performance regarding the diagnosis of malignancy was evaluated for the classic preoperative assessment, including clinical signs, CA 19-9, imaging (computed tomography and magnetic resonance cholangiopancreatography), and International Consensus Guidelines criteria, as well as (18)FDG-PET scan.
Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 22, 32, 100, and 43%, and 83, 100, 100, 94, and 96%, respectively, for comprehensive assessment without and with (18)FDG-PET [maximum standardized uptake value (SUV(max)) cutoff of 2.5 MBq]. Elevated CA 19-9 values and positive PET scan were the only independent prognostic factors for malignancy (odds ratio 2.11, 95% confidence interval 1.15-2.74 and 5.49, 95% confidence interval 3.98-21.44, respectively).
(18)FDG-PET is useful for detection of malignancy in IPMN, improving the differential diagnosis with benign cases by functional data. The choice of SUV(max) cutoff should maximize specificity.
胰腺导管内乳头状黏液性肿瘤（IPMN）的恶性肿瘤可以根据许多临床和影像学特征来预测，这些特征已经提高了敏感性，但特异性低至 20-50%。我们试图证实（18）F-18-氟脱氧葡萄糖正电子发射断层扫描（（18）FDG-PET）在基于影像学的 IPMN 恶性肿瘤评估中的诊断准确性方面的额外价值。
本前瞻性非对照病例系列包含 44 例接受全面诊断评估的 IPMN 患者，包括磁共振胰胆管成像和（18）FDG-PET。平均随访时间为 39.3 个月（范围 3-97 个月）。评估了经典术前评估、包括临床症状、CA 19-9、影像学（计算机断层扫描和磁共振胰胆管成像）和国际共识指南标准以及（18）FDG-PET 扫描在内的恶性肿瘤诊断的诊断性能。
综合评估无（18）FDG-PET 和有（18）FDG-PET[最大标准化摄取值（SUV(max)）截断值为 2.5 MBq]时，敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 100%、22%、32%、100%和 43%、83%、100%、100%、94%和 96%。升高的 CA 19-9 值和阳性 PET 扫描是恶性肿瘤的唯一独立预后因素（优势比 2.11，95%置信区间 1.15-2.74 和 5.49，95%置信区间 3.98-21.44）。
（18）FDG-PET 可用于检测 IPMN 中的恶性肿瘤，通过功能数据改善与良性病例的鉴别诊断。SUV(max)截断值的选择应使特异性最大化。
