Objectives: To assess the ability of [18F]FDG PET/CT for distinguishing malignant from benign lesions of the pancreas and to evaluate the prognostic value of SUVmax in solid and cystic lesions. Methods: We reviewed 94 [18F]FDG PET/CT examinations performed in three different Institutions in patients with radiological suspicion of malignancy. We studied a total of 96 histologically confirmed lesions (39 malignant, 57 benign); 2 patients had 2 different pancreatic lesions. Follow-up was available for 85/94 patients. Results: The mean SUVmax of malignant lesions (5.6±3, range 1.3-17) was significantly higher than that of benign lesions (1.9±0.9 range 0.5-5). With a cut-off SUVmax <=2.4 for benign lesions, overall sensitivity and specificity of PET/CT for distinguishing malignant from benign pancreatic lesions were 93% and 87%, respectively. PPV was 91.5% and NPV was 89.5%. For cystic lesions (n=49), SUVmax <=2.1 as cut-off resulted in 80% sensitivity and 79.5% specificity, with 50% PPV and 94% NPV. There was a significant difference in SUVmax between malignant lesions (4.2±2.7, range 1.3-9) and benign lesions (1.9±1, range 0.5-5). 45/85 patients with long-term follow-up had pancreatic cancer. Analyzing SUVmax as prognostic factor for survival, Kaplan-Meier curves discriminated 3 subgroups with significantly different survivals: 1) 38 patients with SUVmax <=2.4 and longer survival (no deaths, median follow-up 42.5 months); 2) 22 patients with SUVmax 2.5-4.5 (4 deaths, median follow-up 21 months); and 3) 27 patients with SUVmax >4.6 (17 deaths, median survival 25 months, median follow-up 19 months). Conclusions: [18F]FDG PET/CT is useful to characterize suspicious pancreatic masses and allows differentiation of benign from malignant lesions. Moreover, SUVmax of pancreatic tumors correlates with the overall survival of patients.
Role of [18F] FDG PET/CT for distinguishing benign and malignant pancreatic lesions
2013
Abstract
Objectives: To assess the ability of [18F]FDG PET/CT for distinguishing malignant from benign lesions of the pancreas and to evaluate the prognostic value of SUVmax in solid and cystic lesions. Methods: We reviewed 94 [18F]FDG PET/CT examinations performed in three different Institutions in patients with radiological suspicion of malignancy. We studied a total of 96 histologically confirmed lesions (39 malignant, 57 benign); 2 patients had 2 different pancreatic lesions. Follow-up was available for 85/94 patients. Results: The mean SUVmax of malignant lesions (5.6±3, range 1.3-17) was significantly higher than that of benign lesions (1.9±0.9 range 0.5-5). With a cut-off SUVmax <=2.4 for benign lesions, overall sensitivity and specificity of PET/CT for distinguishing malignant from benign pancreatic lesions were 93% and 87%, respectively. PPV was 91.5% and NPV was 89.5%. For cystic lesions (n=49), SUVmax <=2.1 as cut-off resulted in 80% sensitivity and 79.5% specificity, with 50% PPV and 94% NPV. There was a significant difference in SUVmax between malignant lesions (4.2±2.7, range 1.3-9) and benign lesions (1.9±1, range 0.5-5). 45/85 patients with long-term follow-up had pancreatic cancer. Analyzing SUVmax as prognostic factor for survival, Kaplan-Meier curves discriminated 3 subgroups with significantly different survivals: 1) 38 patients with SUVmax <=2.4 and longer survival (no deaths, median follow-up 42.5 months); 2) 22 patients with SUVmax 2.5-4.5 (4 deaths, median follow-up 21 months); and 3) 27 patients with SUVmax >4.6 (17 deaths, median survival 25 months, median follow-up 19 months). Conclusions: [18F]FDG PET/CT is useful to characterize suspicious pancreatic masses and allows differentiation of benign from malignant lesions. Moreover, SUVmax of pancreatic tumors correlates with the overall survival of patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
