Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-d-glucose for the differentiation of chronic pancreatitis and pancreatic cancer

Abstract

Background The clinical presentation of patients with pancreatic cancer may resemble the clinical picture of chronic pancreatitis. A definitive preoperative diagnosis is not always obtained in patients with a history of chronic pancreatitis despite the use of modern imaging techniques. Operative strategy therefore remains unclear before operation in these patients. Methods Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG) was introduced recently into clinical oncology because of its ability to demonstrate metabolic changes associated with various disease processes. The impact of FDG-PET on the differentiation of chronic pancreatitis and pancreatic cancer was investigated. FDG-PET was performed in 48 patients with chronic pancreatitis (n = 12), acute pancreatitis (n = 3) and pancreatic cancer (n = 27), and in controls (n = 6). Histological examination was undertaken in all cases except controls. The FDG-PET results were obtained without knowledge of results of other imaging procedures. The results were then compared with those of computed tomography, ultrasonography, endoscopic retrograde cholangiopancreaticography, operative findings and histology. PET images were analysed semiquantitatively by calculating a standard uptake value (SUV) 90 –120 min after application of the tracer. Results Cut-off values were validated as follows: SUV greater than 4·0 for pancreatic cancer, SUV of 3·0 – 4·0 for chronic pancreatitis, and SUV of less than 3·0 for controls. Sensitivity and specificity of PET imaging were 0·96 and 1·0 for pancreatic cancer, and 1·0 and 0·97 for chronic pancreatitis. In five cases only FDG-PET led to the correct preoperative diagnosis. Conclusion The results give further evidence that FDG-PET is an important non-invasive method for the differentiation of chronic pancreatitis and pancreatic cancer. Delayed image acquisition in the glycolysis plateau phase permits improved diagnostic performance. This imaging technique is extremely helpful before operation in patients with an otherwise unclear pancreatic mass, despite its costs.