Impact of F18-fluorodeoxyglycose positron emission tomography/ computed tomography on the management of resectable pancreatic tumours Jinna Yao,* Gary Gan,* David Farlow,† Jerome M. Laurence,* Michael Hollands,*‡ Arthur Richardson,*‡ Henry C. C. Pleass*‡ and Vincent W. T. Lam*‡ *Department of Surgery, Westmead Hospital †Department of Nuclear Medicine and Ultrasound, Westmead Hospital, and ‡Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia Key words pancreatic cancer, positron emission tomography, surgical oncology. Correspondence Dr Vincent Lam, Department of Surgery, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia. Email: vincent.lam@sydney.edu.au J. Yao MBBS, BSc; G. Gan MBBS, BSc; D. Farlow MBBS, FRACP; J. M. Laurence MBChB, PhD, FRACS; M. Hollands MBBS, FRACS; A. Richardson MBBS, FRACS; H. C. C. Pleass MBBS, MD, FRACS; V. Lam MBBS, MS, FRACS. This paper is based on a previous presentation at the 2010 Annual Scientific Congress of the Royal Australasian College of Surgeons in Perth, Australia. Accepted for publication 28 August 2011. doi: 10.1111/j.1445-2197.2011.05972.x Abstract Background: Positron emission tomography/computed tomography (PET/CT) using F18-fluorodeoxyglucose has been shown to be valuable in the management of malig- nant disease. The aim of this study is to investigate the impact of this technique on the management of patients with resectable pancreatic tumours. Methods: Thirty-six patients with 37 potentially resectable pancreatic tumours on diagnostic CT imaging underwent PET/CT scans. Operative findings, histological reports and/or clinical follow-up served as standard of reference. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT. Results: Pancreatic adenocarcinoma was diagnosed in 30 patients, neuroendocrine tumours in 3, mass-forming pancreatitis in 3 and serous cystadenoma in 1. The median standard uptake (max) value was 5.0 (range 2.2–12.0). Sensitivity and specificity of detecting extrapancreatic metastatic disease were 73% and 100%, respectively. Three occult liver metastases were detected at laparotomy following negative PET/CT. PET/CT findings influenced the management of 8 (22%) patients – 3 with liver metastases, 3 with bone metastases, 1 with lymph node metastases and 1 by identify- ing the benign appearance of the pancreatic tumour. Conclusion: PET/CT achieves a significant diagnostic impact in detecting extrapan- creatic metastatic disease. F18-fluorodeoxyglucose PET/CT appears to be useful in assessing suspicious pancreatic masses. Introduction Pancreatic cancer has a dismal prognosis with a reported 5-year survival rate of less than 5%. 1 It is estimated that less than 25% of pancreatic cancers are amenable to resection during surgical exploration. 2–5 Even if patients undergo surgery and adjuvant che- motherapy, the 5-year survival rate remains poor at less than 20%. 1 Despite the recent advances in surgical techniques and perioperative management of patients, the morbidity and mortality rates after pancreatectomy remain high at 30–50% and 2–4%, respectively, even in high-volume centres. 6,7 It is important to note that the sur- vival rate in patients who undergo incomplete resection is no differ- ent from that of patients with surgically unresectable disease treated with chemoradiation. 8 These facts highlight the importance of accu- rate staging, in particular the detection of occult distant metastases (Fig. 1). At present, the pathway for diagnosis and staging of patients with pancreatic tumours remains challenging. Contrast-enhanced multi- detector computed tomography (CT) scans, magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS) are the most commonly used imaging modalities to investigate pancreatic tumours. Diagnostic pathways differ between institutions and according to availability. F18-fluorodeoxyglycose (FDG) positron emission tomography (PET) is the latest non-invasive imaging modality that exploits the increased glucose metabolism by tumour cells. With the introduction ORIGINAL ARTICLE ANZJSurg.com © 2012 The Authors ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons ANZ J Surg 82 (2012) 140–144