ORIGINAL ARTICLE Positron Emission Tomography (PET) has Limited Utility in the Staging of Pancreatic Adenocarcinoma Peter Einersen & Irene Epelboym & Megan D. Winner & David Leung & John A. Chabot & John D. Allendorf Received: 7 November 2013 /Accepted: 15 April 2014 # 2014 The Society for Surgery of the Alimentary Tract Abstract Background Positron emission tomography (PET) as an adjunct to conventional imaging in the staging of pancreatic adenocar- cinoma is controversial. Herein, we assess the utility of PET in identifying metastatic disease and evaluate the prognostic potential of standard uptake value (SUV). Methods 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. Results 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). Conclusion 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. Keywords Pancreas . PET . Radiology . Pancreatic adenocarcinoma . Cancer staging Introduction Pancreatic adenocarcinoma carries the worst prognosis of all the gastrointestinal malignancies, with a 5-year survival of only 6 %. 1 At present, only surgical resection can offer the chance at cure, yet less than 20 % of patients with pancreatic cancer have resectable disease at presentation. Nearly half have metastatic lesions, and the remaining patients have locally advanced dis- ease, for which the mainstay of therapy is chemotherapy and/or radiation. Early detection and accurate stratification into the appropriate treatment arm is therefore essential to successful management of the disease. Computed tomography (CT) is the current gold standard for imaging patients with suspected pancreatic cancer 2,3 who are undergoing evaluation for potential resection, but this modality has limitations with respect to the detection of small tumors and metastases. MRI is another conventional imaging modality that offers several benefits in the diagnosis of pan- creatic adenocarcinoma including better soft tissue contrast and higher resolution of the ductal structures, 4,5 In recent D. Leung CUMC Department of Radiology, Columbia University, New York, NY, USA J. A. Chabot : J. D. Allendorf (*) CUMC Department of Surgery, Columbia University, 161 Fort Washington Avenue, Suite 820, New York, NY 10032-3784, USA e-mail: jallendorf@winthrop.org P. Einersen : I. Epelboym : M. D. Winner Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA J. D. Allendorf Winthrop University Medical Center, New York, NY, USA J Gastrointest Surg DOI 10.1007/s11605-014-2529-x