| Objective:To evaluate the diagnostic value of PET-CT, CT and CA19-9 in the diagnosis of pancreatic cancer by the open, clinical, prospective study.(1) To study the diagnostic value of FDG-PET-CT in the differential diagnosis of pancreatic malignant disease(2) To study the diagnostic value of dual-phase-FDG PET in the differential diagnosis of pancreatic malignant disease(3) To study the value of 18F-FDG PET-CT in the preoperative staging of pancreatic cancerMethods:Patients with suspected pancreatic mass were given preoperative diagnosis test consisted of PET-CT,64-slice CT and CA19-9 in Huashan Hospital. Pathological diagnosis was taken as golden standard. The sensitivity, specificity, positive prospective value (PPV), negative prospective value (NPV) and diagnostic accuracy of PET-CT, CT and CA19-9 were calculated for analysis of diagnostic value.The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET-CT for detecting lymph node, liver and other distant metastasis were also evaluated.The SUVmax and SUVdelay of PET-CT of benign and malignant pancreatic disease were evaluated among cases with and without pathological results. The retention index was calculated among the cases which took the dual-phase-FDG PET-CT. ROC curves of SUVmax and SUVdelay were made to compare the value of dual-phase-FDG PET-CT.Results: (1) Patients Characters:1) From 2008.09 to 2009.11,92 patients with suspected pancreatic mass were included into this study. All patients were given PET-CT scan before being treated.67 of them have reached an pathological results, other 25 patients were diagnosed by surgical and clinical findings. There were total 51 males and 41 females with a mean age of 60.41±10.74 years old (range from 38-89 years old).2) 50 patients of all were treated with surgical procedures and 17 treated with palliative surgical procedures.19 patients undertook intro-arterial chemotherapy,3 regular chemotherapy and 1 radiotherapy.(2) The value of PET-CT in the diagnosis and preoperative staging of pancreatic cancer1) The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET-CT for detecting malignancy were 92.45%,57.14%,89.09%,66.67%, 85.07% respectively. PET-CT seems to be superior to CT in the sensitivity (79.59%, p=0.054) and the diagnostic accuracy (73.02%, p=0.07). The combination of CT and CA19-9 had a higher sensitivity (97.78%)and NPV(80.00%), but without statistic difference. Taking all patients into consideration, the sensitivity of PET-CT increased to 93.58%((n=92), being superior to CT(84.72%,n=86,p=0.045<0.05) and CA19-9(85.14%,n=86,p=0.047<0.05)2) The sensitivity, specificity, PPV, NPV, diagnostic accuracy of PET-CT in the detection of lymph node metastasis were 25%,100%, 100%,48.57% and 56.10% respectively.12 cases with metastatic lymph nodes were detected by PET-CT among 25 patients and treated with non-surgical therapy.3) PET-CT had a sensitivity of 70.00%, a specificity of 100%, a PPV of 100%, a NPV of 91.11 and a accuracy of 96.15% for diagnosis of liver metastasis(n=50). Taking all clinical diagnosed cases into consideration, the sensitivity, NPV and accuracy improved to 88.00%,94.12%,95.89%(n=73), being significant superior to CT(45.83%,97.44%,91.67%,74.51%,77.78%,p<0.05).20 patients avoided unnecessary surgery because of liver and/or other distant metastasis by PET-CT.(3) The cut-off point of SUVmax for pancreatic malignant diseaseThe medium SUVmax of malignant pancreatic disease is 5.4 (range from 1.4 to 20.5) and was significantly different from that of benign pancreatic disease (2.5, range from 1.0 to 7.9). Dual-phase FDG-PET; 6 of 27 malignant cases showed a decline in the SUV. The average RI of malignant disease had no significantly different from benign disease (18.56% vs 18.59%,p=0.664). The ROC showed an AUC of 0.813 for SUVmax, 95%CI (0.682,0.944) and an AUC of 0.782 for SUVdelay,95%CI (0.600,0.964). The appropriate cut-off point for benign and malignant pancreatic disease is 3.05 with a sensitivity of 90.70% and a specificity of 66.70%.Conclusion:(1)PET-CT seems to be superior to CT in the detection of pancreatic malignance with more sensitivity and accuracy of diagnosis.(2)Because of detecting the liver metastasis and other distant metastasis (including lymph node metastasis) by PET-CT preoperatively, unnecessary surgical operations were avoided.(3)The SUVmax of benign and malignant pancreatic disease was statistically different.3.05 may be the appropriate cut-off point for diagnosis. |
PDF Full Text Request