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1998 Abstract: THE ROLE OF POSITRON EMISSION TOMOGRAPHY (PET SCAN) IN THE DIAGNOSIS AND STAGING OF PANCREATIC CANCER. Lisa Clark*, R. Anthony Perez-Tamayo, Herb Hurwitz, Stan Branch, John Baillie, Paul Jowell, Edward Coleman, Theodore Pappas, Mary Keogan, and Douglas Tyler. Duke University Medical Center, Durham, North Carolina. 116

Abstracts
1998 Digestive Disease Week

#1020

THE ROLE OF POSITRON EMISSION TOMOGRAPHY (PET SCAN) IN THE DIAGNOSIS AND STAGING OF PANCREATIC CANCER. Lisa Clark*, R. Anthony Perez-Tamayo, Herb Hurwitz, Stan Branch, John Baillie, Paul Jowell, Edward Coleman, Theodore Pappas, Mary Keogan, and Douglas Tyler. Duke University Medical Center, Durham, North Carolina.

Objective: To investigate the efficacy and clinical utility of PET scan in patients with suspected pancreatic cancer.

Methods: Thirty patients with suspected pancreatic neoplasms underwent whole body PET scan following injection of F-18-Deoxyglucose (FDG). Areas of abnormality on FDG PET scan were identified visually as areas of increased focal metabolic activity compared to background tissue. These areas were also quantified with respect to background uptake. Each scan was evaluated for the presence and absence of local disease, regional nodal disease, and distant metastatic disease. Patients also underwent enhanced, thin cut dynamic CT scan of the abdomen and pelvis. Areas of abnormality and lymph nodes greater than 1 cm were recorded as positive findings. Lesions were defined histologically in all patients using fine needle aspiration, core biopsy, and/or surgical resection.

Results: Pancreatic cancer was confirmed histologically in 22 of 30 patients. FDG PET scan had a sensitivity of 82% and a specificity of 75% as compared to dynamic enhanced CT scan which had a sensitivity of 82% and a specificity of 63% in the same patient population (not statistically significant). There were four false negative PET scans in patients with primary tumors detected by CT scan. Three of the false negative tumors were adenocarcinoma, one was a neuroendocrine tumor, and all four measured greater than 2 cm in diameter. There were also two patients with positive PET scans who underwent surgical resection and had no evidence of pancreatic cancer on final pathologic examination. In the 22 patients with pancreatic cancer, PET scan failed to reveal any extrapancreatic disease not seen on CT scan. In addition, PET scan did not demonstrate increased regional signal intensity in the 2 resected patients who had microscopic disease in their peripancreatic lymph nodes.

Conclusion: PET scan did not have the sensitivity and specificity necessary to definitively diagnose pancreatic cancer, and its resolution provides no anatomic information. In addition, it failed to identify small volume, CT-invisible, metastatic disease. Therefore, in the diagnosis and staging of pancreatic cancer, FDG PET scan does not offer any advantage over enhanced, thin cut dynamic CT scan that could potentially spare patients unnecessary exploration or resection.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.



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