18-Fluoride fluorodeoxyglucose positron emission tomography is impactful in newly diagnosed pancreatic adenocarcinoma

Abstract

BACKGROUND: Adenocarcinoma of the pancreas has a dismal prognosis. Surgical resection increases survival but is reliant on accurate detection and staging of disease. In overseas studies, 18 F-FDG positron emission tomography (PET) has been shown to have high diagnostic accuracy and staging utility, but local data remain sparse, in part because the technique has hitherto been unfunded via the Medicare benefits schedule. Although Commonwealth funding for rare tumours (including of the pancreas) has been recently approved to commence in late 2022, the proposed item descriptor wording implies that PET should lead to a significant change in management. Accordingly, the aims of this study are to characterize PET findings in newly diagnosed pancreatic adenocarcinoma using standard parameters, such as the SUVmax , and assess the proportion of cases in which PET altered initial management planning. METHODS: We analysed the PET findings of these cancers (presence and degree of metabolic activity in the primary lesion, as well as within malignant nodal and metastatic lesions) and compared the pre- and post-PET management plans of the referring specialists. RESULTS: Of 51 patients we found that (a) increasing SUVmax of the primary lesion correlated with an increase in disease stage (r-value = 0.335; P-value = 0.016), and (b) PET contributed to a significant change in management in 35% of patients. CONCLUSION: In newly diagnosed pancreatic adenocarcinoma, parameters in PET correlate with disease stage and the overall findings contribute to a significant management change in about 35% of patients. Copyright �� 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.