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PET Scan in Cystic Tumors of the Pancreas

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Cystic Tumors of the Pancreas

Abstract

Characterization of the pancreatic cystic lesion with reliable, noninvasive methods is crucial to distinguish benign from malignant cystic tumors of the pancreas in order to plan treatment options or follow-up. Despite evaluation with sophisticated preoperative investigations, a correct pathologic diagnosis rate does not exceed 68 %, due to heterogeneous variety of lesions with different behaviors, resulting often in over- or undertreatment of these lesions.

2-[18 F]-Fluoro-2-deoxy-D-glucose positron emission tomography has been found to be a highly sensitive and specific noninvasive procedure to detect malignancy in cystic tumors of the pancreas, and improvement in the equipment in the last decade, with the introduction of hybrid PET/CT scans, allowed a more accurate localization of the foci of hypermetabolism. We reviewed 10 series of patients who underwent FDG-PET from 2001, and, in the last studies, sensitivity in detecting malignancy ranged from 83 to 100 % and specificity from 87 to 100 %. The FDG-PET for a long time was still looking for a role in the diagnostic workup, restricted so far in those cases in which conventional imaging was insufficient to rule out a cancer. FDG-PET was found to be reliable to detect “cancer in situ” then “early-stage cancer” when no other investigation could detect it. Since many of these cystic neoplasms are left in surveillance, we stress the use of FDG-PET in the first assessment of these patients, as alternative to EUS with FNA, to exclude to overlook a cancer. We are lacking data about the use of FDG-PET and timing in the follow-up of patients (un)operated. The high rate of extrapancreatic cancers in intraductal papillary mucinous neoplasms and multifocality of this disease suggest a regular use in the follow-up of these patients.

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Author information

Authors and Affiliations

  1. Department of Surgery, Oncology, Gastroenterology, Policlinico – University of Padova, Padova, Italy

    Claudio Pasquali MD & Anna Caterina Milanetto MD

  2. Unit of Pancreatic and Digestive Endocrine Surgery, Clinica Chirurgica 1, Via Giustiniani 2, Padova, 35128, Italy

    Claudio Pasquali MD & Anna Caterina Milanetto MD

Authors
  1. Claudio Pasquali MD
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  2. Anna Caterina Milanetto MD
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Correspondence to Claudio Pasquali MD .

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Editors and Affiliations

  1. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden

    Marco Del Chiaro

  2. Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden

    Stephan L. Haas

  3. Department of Surgery, University of Colorado at Denver Aurora, Colorado, USA

    Richard D. Schulick

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Pasquali, C., Milanetto, A.C. (2016). PET Scan in Cystic Tumors of the Pancreas. In: Del Chiaro, M., Haas, S., Schulick, R. (eds) Cystic Tumors of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-319-31882-0_8

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  • DOI: https://doi.org/10.1007/978-3-319-31882-0_8

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