DIAGNOSIS OF PANCREATIC-CANCER BY 2[F-18]-FLUORO-2-DEOXY-D-GLUCOSE POSITRON EMISSION TOMOGRAPHY

The detection of pancreatic cancer or the discrimination between pancr eatic cancer and chronic pancreatitis remains an important diagnostic problem. The increased glucose metabolism in malignant tumours formed the basis for this investigation, which focused on the role of positro n emission tomography with 2[F-18]-fluoro-2-deoxy-D-glucose (FDG) in t he detection of pancreatic cancer and its differentiation from chronic pancreatitis. Eighty patients admitted for elective pancreatic surger y received preoperatively 250-350 mBq FDG intravenously and emission s cans were recorded 45 minutes later. Intense focal activity in the pan creatic region was taken at the time of scanning as showing the presen ce of pancreatic cancer. The presence of cancer was later confirmed by histological examination of the surgical specimens and histological f indings were compared with the preoperative PET results. Forty one pat ients with pancreatic cancer (group I: n=42) had a focally increased F DG uptake in the pancreatic region. Two patients with a periampullary carcinoma (group II: n=6) failed to develop FDG accumulation. In 28 pa tients with chronic pancreatitis (group III: n=32) no FDG accumulation occurred. Overall sensitivity and specificity of PET for malignancy ( group I+II) were 94% (45 of 48) and 88% (28 of 32), respectively. The standard uptake value of the patients with pancreatic carcinoma was si gnificantly higher than in patients with chronic pancreatitis (3.09 (2 .18) v 0.87 (0.56); p<0.001; median (interquartile range)). These find ings show that FDG-PET represents a new and non-invasive diagnostic pr ocedure for the diagnosis of pancreatic cancer and to differentiate pa ncreatic cancer from chronic pan-creatitis. However, the diagnostic po tential of this technique requires further evaluation.