The Applicati Of¹⁸F-FDG PET/CT For Differentiating Pancreatic Carcinoma From Chronic Mass-forming Pancreatitis And In Preoperative Assessment Of Pancreatic Carcinoma

Objective:1.To explore the value of18F-FDG PET/CT image for differentiatingpancreatic carcinoma(PC) from chronic mass-forming pancreatitis(CMFP).2.Todiscuss the value of18F-FDG PET/CT image in the preoperative staging andassessment of PC.3.To analyse the value of CA19-9in diagnosing PC.Materials and Methods:1.Study objectiveControl group:10healthy examination people was selected as control group.Allpeople had no past history and present history of pancreatic disease. CMFP group:20patients with CMFP were selected for this study. PC group:40patients with PC wereselected for this study.18F-FDG PET/CT imaging was performed in all the studyobjective,all proved by comprehensive methods as surgery pathology、other diagnosticmeasures or clinical follow-up.2.PET/CT image analysis and diagnostic criteriaA retrospective analysis was performed on all the study objective.Images wereinterpreted and compared with the histopathologic findings at surgery or with clinicalfollow-up findings.The sensitivity,specificity and accuracy of PET/CT diagnosis wereanalyzed.The early SUVmax of primary tumour,the metastases of local and distantlymph node and foci of distant metastasis were record.The positive level of SUVmaxwas more than3.0.3.Serum carbohydrate antigen19-9(CA19-9) determinedThe level of serum CA19-9was determined before operation,takingCA19-9>37U/ml as abnormal criteria.4.The diagnostic criteria ofl8F-FDG PET/CT combined with CA19-9Both were abnormal,the united diagnosed as positive;one normal or if the two were normal,the combined diagnosis was negative.5.Statistical analysisAll data calculations were performed using SPSS,version17.0,and P values of lessthan0.05were considered as statistical significance.Results:1.Control groupIn control group,pancreas has no abnormal18F-FDG uptake.2.Patient group2.118F-FDG PET/CT image diagnosisThe sensitivity,specificity and accuracy of PET/CT in differentiating PC fromCMFP were95%,60%,83.3%,respectively.The difference of average SUVmax inPC,CMFP and control group was statistically significant (P<0.05).2.2Serum levels of CA19-9The sensitivity,specificity,accuracy of CA19-9in differentiating PC from CMFPwere87.5%,60%,78.3%,respectively.The level of CA19-9between PC and CMFP hadsignificant difference(t=3.676,P=0.0005).2.318F-FDG PET/CT combined with CA19-9diagnose PCThe sensitivity,specificity,accuracy of18F-FDG PET/CT combined with CA19-9in differentiating PC from CMFP were90%,90%,90%,respectively.2.4The value of18F-FDG PET/CT in detection of metastases and staging2.4.1Lymph nodes metastasesThe sensitivity,specificity and accuracy of PET/CT in detecting lymph nodemetastasis were45.5%,86.7%,69.2%, respectively.2.4.2Distant metastasesAmong the40patients,18F-FDG PET/CT discovered15patients with organsand/or tissue metastases(37.5%).10cases had metastasis to a single organ or tissue.5cases had multiple organs and/or tissue metastasis.2.5The application of18F-FDG PET/CT in assessment of resectability of PC(Inaccordance with the standards of the2010NCCN) 25patients underwent surgical exploration.The accuracy of preoperativeevaluation of resectability by PET/CT and intraoperative evaluation was80%.Therewas no significant difference between PET/CT and the findings in surgery andhistopathology in evaluating the curative resectability of PC(χ2=0.000,P>0.05).2.6The significance of serum CA19-9in PC surgeryThe difference of serum CA19-9level in resectable and unresectable PC patientswas not statistically significant (t=0.662，P=0.512).Conclusions:1.PET/CT has a high sensitivity,specificity and accuracy in the diagnosis ofPC,especially in differentiating PC from CMFP.2.In detecting lymph node metastasis and distant metastasis,it’s also of greatvalue.Thus,18F-FDG PET/CT is helpful in the preoperative staging and assessment ofresectability of PC,then affecting the selection of therapeutic scheme.3.Serum CA19-9measurement is conductive to18F-FDG PET/CT for differentiatingPC from CMFP.But,the value of assessment of resectability of PC guided by the levelof CA9-9requires further study.