Clinical impact of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic cancer

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Abstract
Purpose To evaluate the diagnostic accuracy of fluorine-18-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) for lymph node (LN) metastasis and the prognostic significance of 18F-FDG PET/CT LN parameters in patients with resectable pancreatic cancer. Patients and methods Patients with resectable pancreatic cancer who underwent staging 18F-FDG PET/CT between May 2007 and September 2016 were retrospectively enrolled and analyzed through medical record and image re-evaluation. The diagnostic accuracy of 18F-FDG PET/CT in predicting LN metastasis was evaluated and compared with that of contrast-enhanced abdominal computed tomography (CECT). Prognostic variables, including LN parameters assessed by 18F-FDG PET/CT [standardized uptake value (SUV)LN and LN/tumor SUV ratio], that affect disease-free survival (DFS) and overall survival (OS) were evaluated by regression analysis. Results When predicting LN metastasis, 18F-FDG PET/CT showed greater sensitivity, positive predictive value, negative predictive value, and accuracy than CECT. Among prognostic factors affecting DFS, PET-positive LN (P=0.008), and LN/tumor SUV ratio (P=0.003) were found to be significant by regression analysis. Among the variables affecting OS, lymphovascular invasion (P=0.018) and the LN/tumor SUV ratio (P=0.046) were found to be significant. Conclusion 18F-FDG PET/CT showed higher diagnostic accuracy in predicting LN metastasis than CECT in patients with resectable pancreatic cancer. Only the LN/tumor SUV ratio of 18F-FDG PET/CT was an independent prognostic variable in both DFS and OS.

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