Abstract
Simple SummaryPancreatic cancer (PC) has a severe prognosis and even after radical surgery, relapse rate is very high (70–80%). The impact of PET/CT in PC clinical management has been increasingly investigated in the last decades. As regards localized and potentially resectable disease, the role of PET/CT is still controversial and international guidelines do not recommend its routine use. Despite this, PET may play a role in assessing PC stage and grade and potential resectability after neoadjuvant treatment. Aim of this review is to discuss the current use for staging and disease response assessment and future developments of PET/CT in resectable PC.Pancreatic Cancer (PC) has a poor prognosis, with a 5-year survival rate of only 9%. Even after radical surgical procedures, PC patients have poor survival rates, with a high chance of relapse (70–80%). Imaging is involved in all aspects of the clinical management of PC, including detection and characterization of primary tumors and their resectability, assessment of vascular, perineural and lymphatic invasion and detection of distant metastases. The role of Positron Emission Tomography/Computed Tomography (PET/CT) in detecting PC is still controversial, with the international guidelines not recommending its routine use. However, in resectable PC, PET/CT may play a role in assessing PC stage and grade and potential resectability after neoadjuvant treatment. Quantitative image analysis (radiomics) and new PET/CT radiotracers account for future developments in metabolic imaging and may further improve the relevance of this technique in several aspects of PC. In the present review, the current state of the art and future directions of PET/CT in resectable PC are presented.
Highlights
The correct and timely identification of initial stage of malignancies is of paramount importance to plan therapeutic strategies which might cure the disease, improve diseasefree survival and patients’ quality of life
A relevant example is the case of pancreatic carcinoma (PC) in which early detection of stage, nodal metastases and occult liver metastases is mandatory to choose the more suitable treatment option
Among PC patients, Positron Emission Tomography/Computed Tomography (PET/Computed Tomography (CT)) was perceived to have changed the planned management in 43% of the cases: in 11% of patients, resection was withdrawn after PET due to restaging of the disease, while in 13% of the cases surgery was planned after an initial non-surgical indication
Summary
The correct and timely identification of initial stage of malignancies is of paramount importance to plan therapeutic strategies which might cure the disease, improve diseasefree survival and patients’ quality of life. Due to the heterogeneity of the published studies and the type of pancreatic lesions, it is not possible to identify a gold standard diagnostic technique used to differentiate benign and malignant pancreatic lesions In this context, PET/CT could provide useful information aimed at improving diagnosis considering its high sensitivity but not replacing other imaging techniques due to low specificity [25]. In a retrospective study by Ergul et al, PET/CT showed a sensitivity and specificity of 100% and 89.5% in the differential diagnosis between malignant and benign lesions [26], while in a recent prospective study by Krishnaraju et al, sensitivity and specificity decreased to 89% and 57%, respectively [27] It has been reported a possible increase of the diagnostic performance of PET/CT by using SUV cut-off and FDG uptake pattern to discriminate benign vs malignant lesions [28,29]. No definitive conclusion could be drawn and PET/CT or EUS/FNA could be adopted in diagnostic pathway to discriminate benign from malignant lesions according to center expertise and preferences
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