Detection of recurrence after resection of pancreatic and periampullary malignancies is often difficult, and recurrent disease, when detected, is usually incurable. In this study we tried to determine the role of 18-FDG PET in detecting recurrences.
Methods: From January 1998 to December 2003, forty-two patients (18 males and 24 females, mean age 62.7 years, range 37-84) underwent FDG PETafter resection of pancreatic (n=29) or periampullary cancers (n=13). All patients underwent US, helical CT, chest x-ray and serum tumour markers assay (CEA and CA 19-9). Mean follow-up was 29.3 months, range 6-76. Results: Twenty-eight patients showed tumour's recurrence; 21 (75%) had high serum CA 19-9 levels. Sensitivity of FDG PET and CT-scan in detecting tumour's relapse was 91% (27/28) and 57% (16/28), respectively. Nine out of 12 patients with FDG PET positive/CTscan negative recurrent tumours were asymptomatic: 5 patients underwent resection (3 paraortic lymph-nodes, 2 liver metastasis), 5 chemotherapy, 1 radiotherapy, and 1 supportive therapy. A second primary tumour was detected by FDG-PET and resected in three patients (1 lung and 2 colon carcinomas). A wedge hepatic resection was performed for a CTscan positive, FDG-PET negative lesion. Eleven patients showed no recurrence: FDG PET was negative in all patients, while one patient had transient elevation of CA 19-9 levels and 3 had equivocal CT or US findings. FDG PET altered the clinical management in 8/31 (26%) patients. Conclusion: FDG PET is very sensitive in detecting recurrent periampullary carcinomas allowing changes in the management in one fourth of the patients.
500 Cummings Center
+1 978-927-8330
+1 978-524-0498
