Einersen Peter, Epelboym Irene, Winner Megan D, Leung David, Chabot John A, Allendorf John D
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Gastrointest Surg. 2014 Aug;18(8):1441-4. doi: 10.1007/s11605-014-2529-x. Epub 2014 Jun 14.
Positron emission tomography (PET) as an adjunct to conventional imaging in the staging of pancreatic adenocarcinoma is controversial. Herein, we assess the utility of PET in identifying metastatic disease and evaluate the prognostic potential of standard uptake value (SUV).
Imaging and follow-up data for patients diagnosed with pancreatic adenocarcinoma were reviewed retrospectively. Resectability was assessed based on established criteria, and sensitivity, specificity, and accuracy of PET were compared to those of conventional imaging modalities.
For 123 patients evaluated 2005-2011, PET and CT/MRI were concordant in 108 (88 %) cases; however, PET identified occult metastatic lesions in seven (5.6 %). False-positive PETs delayed surgery for three (8.3 %) patients. In a cohort free of metastatic disease in 78.9 % of cases, the sensitivity and specificity of PET for metastases were 89.3 and 85.1 %, respectively, compared with 62.5 and 93.5 % for CT and 61.5 and 100.0 % for MRI. Positive predictive value and negative predictive value of PET were 64.1 and 96.4 %, respectively, compared with 75.0 and 88.9 % for CT and 100.0 and 91.9 % for MRI. Average difference in maximum SUV of resectable and unresectable lesions was not statistically significant (5.65 vs. 6.5, p = 0.224) nor was maximum SUV a statistically significant predictor of survival (p = 0.18).
PET is more sensitive in identifying metastatic lesions than CT or MRI; however, it has a lower specificity, lower positive predictive value, and in some cases, can delay definitive surgical management. Therefore, PET has limited utility as an adjunctive modality in staging of pancreatic adenocarcinoma.
正电子发射断层扫描（PET）作为传统成像的辅助手段用于胰腺癌分期存在争议。在此，我们评估PET在识别转移性疾病中的效用，并评估标准摄取值（SUV）的预后潜力。
回顾性分析诊断为胰腺癌患者的影像学和随访数据。根据既定标准评估可切除性，并将PET的敏感性、特异性和准确性与传统成像方式进行比较。
对2005 - 2011年评估的123例患者，PET与CT/MRI在108例（88%）病例中结果一致；然而，PET识别出隐匿性转移病灶7例（5.6%）。PET假阳性使3例（8.3%）患者手术延迟。在一组78.9%病例无转移性疾病的队列中，PET对转移灶的敏感性和特异性分别为89.3%和85.1%，相比之下，CT分别为62.5%和93.5%，MRI分别为61.5%和100.0%。PET的阳性预测值和阴性预测值分别为64.1%和96.4%，相比之下，CT分别为75.0%和88.9%，MRI分别为100.0%和91.9%。可切除和不可切除病灶的最大SUV平均差异无统计学意义（5.65对6.5，p = 0.224），最大SUV也不是生存的统计学显著预测指标（p = 0.18）。
PET在识别转移病灶方面比CT或MRI更敏感；然而，其特异性较低、阳性预测值较低，且在某些情况下会延迟确定性手术治疗。因此，PET作为胰腺癌分期的辅助手段效用有限。
