Background: Preoperative diagnosis of pancreatic adenocarcinoma can be diff
icult. Computed tomography (CT) is the standard, noninvasive imaging method
for evaluation of suspected pancreatic adenocarcinoma, but it has limited
sensitivity for diagnosis, local staging, and metastases, Endoscopic ultras
ound (EUS) and fluoro-deoxyglucose/position emission tomography (FDG-PET) a
re imaging methods that may improve diagnostic accuracy.
Methods: Thirty-five patients with presumed resectable pancreatic adenocarc
inoma were prospectively evaluated with helical CT, EUS, and FDG-PET.
Results: Sensitivity for the detection of pancreatic cancer was higher for
EUS (93%) and FDG-PET (87%) than for CT (53%), EUS was more sensitive than
CT for local vascular invasion of the portal and superior mesenteric veins,
EUS diagnosis of vascular invasion was associated with poor outcome after
surgery, EUS-guided, fine-needle aspiration allowed tissue diagnosis in 14
of 21 attempts (67%), FDG-PET diagnosed 7 of 9 cases of proven metastatic d
isease, 4 of which were missed by CT. Two of three metastatic liver lesions
suspected by CT were indeterminate for metastases. FDG-PET confirmed metas
tases.
Conclusions: EUS and PET improve diagnostic capability in pancreatic adenoc
arcinoma, EUS is useful in determining local vascular invasion and obtainin
g tissue diagnosis, FDG-PET is useful in identifying metastatic disease. Bo
th techniques are more sensitive than helical CT for identification of the
primary tumor.