PET-CT in the staging of potentially resectable pancreatic cancer

Abstract

Abstract Introduction: Pancreatic adenocarcinoma (PDAC) presents a significant global health challenge particularly as it is generally diagnosed at an advanced stage. Although cross-sectional imaging techniques including multidetector CT (MDCT) are familiar and ubiquitously used the role and value of PET-CT scans in PDAC management remains unclear. Methods: This six-year study analysed patients who underwent PET-CT scans for suspected PDAC. Demographics, cross-sectional imaging and PET-CT results, management decisions, and histology were collected together with rates of operation with curative intent and the time interval between scans and surgical intervention. Results: Among 161 patients, 110 were operable with curative intent but in 51 no surgical intervention was appropriate or possible. Among patients considered operable, 20 had extra pancreatic PET avid lesions while 90 did not. Among those without extra-pancreatic lesions, 68 underwent surgical exploration, 12 were unfit for surgery, and 10 had inflammatory or benign conditions. In the group who underwent surgical exploration, 9 patients were found to have suspected metastasis prior to their PET scans which were not confirmed on subsequent PET-CT scans. Considering all patients who underwent an exploratory laparotomy 48 underwent successful resection and 20 were found to have disease which precluded potentially curative surgery. In the subset of patients with extra-pancreatic lesions, 4 were inoperable due to the demonstration of unequivocal metastasis on PET-CT but the remaining 16 patients underwent surgical exploration when the decision of the HPB MDT was that lesions were equivocal or may be unrelated to the primary pathology. Of these 16 patients, 9 were resectable and 7 were unresectable and PET-CT scans influenced the management of patients in 8% of cases. The median interval between MDCT and PET-CT scans was 27 days with an average of 36.7 days. The median duration between MDT and PET-CT scans was 12.5 days with an average of 20.2 days. Conclusion: PET-CT scans play a crucial role in the management of suspected PDAC, but routine use may not be justified. Further research is needed to identify the subset of patients who benefit most. Clear guidelines for PET scan utilization in clinical practice are required to optimize the role in PDAC management.