Thesis etd-03162012-101618 |
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Thesis type
Tesi di specializzazione
Author
ORSINI, FEDERICA
URN
etd-03162012-101618
Thesis title
Ruolo della [18F]FDG PET/TC nello studio della patologia neoplastica del pancreas esocrino: revisione della casistica pisana.
Department
MEDICINA E CHIRURGIA
Course of study
MEDICINA NUCLEARE
Supervisors
relatore Prof. Mariani, Giuliano
Keywords
- IPMN.
- pancreatic cancer
- positron emission tomography
Graduation session start date
02/04/2012
Availability
Full
Summary
Pancreatic cancer has been called the "silent killer" for its silent onset and subsequent aggressive and highly lethal behavior. Despite recent advances in radiological imaging, the strength of functional imaging lies in its ability to detect malignant disease irrespective of lesion morphology. The purpose of this thesis, which includes a review of prior literature, is to assess the ability of [18F]FDG PET/CT for distinguishing benign and malignant lesions of the pancreas; the potential of [18F]FDG PET/CT has been explored also regarding its ability to provide additional information over routine radiological imaging, in either solid and/or cystic pancreatic lesions (serous adenoma, MCNs and IPMNs) the frequency of which is increasing. To date, literature in this field is rather limited compared with other tumors, and the results reported are not always univocal.
We reviewed 72 [18F]FDG PET/CT examinations performed between January 2006 and December 2011 for diagnostic purposes in patients who had radiological suspicion of malignant pancreatic disease. Histologic confirmation was obtained in all patients.
Sensitivity and specificity of [18F]FDG PET/CT for discriminating between benign and malignant pancreatic lesions were 90% and 87%, respectively, when adopting an SUVmax cut-off of ≤ 2.4 (P<0.0001) for benign lesions; PPV was 86%, while PNV was 92%. Although [18F]FDG uptake in solid pancreatic malignancies is in general relatively lower than in other tumors, it allows anyway detection of malignancies. Moreover, SUVmax of pancreatic lesions correlates with overall survival of patients. Concomitant inflammatory disease do not affect our results.
When considering only the cystic lesions, sensitivity and specificity were 77.8% and 79.5%, respectively, based on an SUVmax cut-off ≤ 2.1 for benign lesions; the corresponding PPV was 44%, while NPV was 94% (P = 0.006). These results suggest that [18F]FDG PET/CT plays a relevant role for treatment decisions; furthermore, a patient-specific follow-up strategy could be defined when SUVmax of the lesion is lower thean 2.1, especially for those lesion that exhibit benign or uncertain radiological findings, as well as in patients for whom total pancreatectomy (with its associated higher risk of surgical complications) would be required based on radiological imaging alone.
This analysis indicates that, contrary to prior disappointing reports, [18F]FDG PET/CT is a highly useful method to characterize suspicious pancreatic masses, especially in patients with inconclusive radiological imaging. Optimized scanning protocols, including better control of blood glucose and correction for motion of organs in the upper abdomen, might further improve the diagnostic performance of [18F]FDG-PET/CT in patients with pancreatic masses.
We reviewed 72 [18F]FDG PET/CT examinations performed between January 2006 and December 2011 for diagnostic purposes in patients who had radiological suspicion of malignant pancreatic disease. Histologic confirmation was obtained in all patients.
Sensitivity and specificity of [18F]FDG PET/CT for discriminating between benign and malignant pancreatic lesions were 90% and 87%, respectively, when adopting an SUVmax cut-off of ≤ 2.4 (P<0.0001) for benign lesions; PPV was 86%, while PNV was 92%. Although [18F]FDG uptake in solid pancreatic malignancies is in general relatively lower than in other tumors, it allows anyway detection of malignancies. Moreover, SUVmax of pancreatic lesions correlates with overall survival of patients. Concomitant inflammatory disease do not affect our results.
When considering only the cystic lesions, sensitivity and specificity were 77.8% and 79.5%, respectively, based on an SUVmax cut-off ≤ 2.1 for benign lesions; the corresponding PPV was 44%, while NPV was 94% (P = 0.006). These results suggest that [18F]FDG PET/CT plays a relevant role for treatment decisions; furthermore, a patient-specific follow-up strategy could be defined when SUVmax of the lesion is lower thean 2.1, especially for those lesion that exhibit benign or uncertain radiological findings, as well as in patients for whom total pancreatectomy (with its associated higher risk of surgical complications) would be required based on radiological imaging alone.
This analysis indicates that, contrary to prior disappointing reports, [18F]FDG PET/CT is a highly useful method to characterize suspicious pancreatic masses, especially in patients with inconclusive radiological imaging. Optimized scanning protocols, including better control of blood glucose and correction for motion of organs in the upper abdomen, might further improve the diagnostic performance of [18F]FDG-PET/CT in patients with pancreatic masses.
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