Staging chest computed tomography and positron emission tomography in patients with pancreatic adenocarcinoma: utility or futility? HPB (Oxford) 2014 Jan;16(1):70-4
Date
03/19/2013Pubmed ID
23496023Pubmed Central ID
PMC3892317DOI
10.1111/hpb.12074Scopus ID
2-s2.0-84890557827 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
OBJECTIVES: This study was conducted to determine if routine staging chest computed tomography (CT) or positron emission tomography (PET) scanning alters the clinical management of patients with newly diagnosed pancreatic adenocarcinoma.
METHODS: All new pancreas cancers seen in medical oncology, radiation oncology and surgery from 1 June 2008 to 20 June 2010 were retrospectively reviewed. Patients with metastatic disease on chest CT or PET, that had been unsuspected on initial imaging, were identified.
RESULTS: Pancreatic adenocarcinoma was present in 247 consecutive patients. Abdominal CT demonstrated metastases in 108 (44%) and localized disease in 139 (56%) patients. Chest CT and PET were not performed in 15 (11%) of these 139 patients. In the remaining 124 patients, CT imaging suggested resectable disease in 46, borderline resectable disease in 52 and locally advanced disease in 26 patients. Chest CT demonstrated an unsuspected lymphoma in one patient with borderline resectable disease and PET identified extrapancreatic disease in two patients with locally advanced disease. Chest CT and PET added no information in 121 (98%) of the 124 patients.
CONCLUSIONS: The addition of chest CT and PET to high-quality abdominal CT is of little clinical utility; additional sites of metastasis are rarely found. As the quality of abdominal imaging declines, the yield from other imaging modalities will increase. Dedicated pancreas-specific abdominal CT remains the cornerstone of initial staging in suspected or biopsy-proven pancreatic cancer.
Author List
Pappas SG, Christians KK, Tolat PP, Mautz AP, Lal A, McElroy L, Gamblin TC, Turaga KK, Tsai S, Erickson B, Ritch P, Evans DBAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinBeth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Professor in the Radiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdenocarcinomaHumans
Medical Futility
Multimodal Imaging
Neoplasm Staging
Pancreatic Neoplasms
Positron-Emission Tomography
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed
Unnecessary Procedures
