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World J Gastroenterol. Nov 14, 2014; 20(42): 15580-15589
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15580
Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer
Xiao-Yi Wang, Feng Yang, Chen Jin, De-Liang Fu
Xiao-Yi Wang, Feng Yang, Chen Jin, De-Liang Fu, Pancreatic Disease Institute, Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Xiao-Yi Wang, Feng Yang, Chen Jin, De-Liang Fu, Department of Surgery, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: Wang XY contributed to the conception and design of the review, data acquisition, analysis and interpretation, drafting and revising the article, and final approval of the version to be published; Yang F contributed to the conception and design of the review, revising it critically for important intellectual content and the final approval of the version to be published; Jin C and Fu DL contributed to the conception and design of the review and final approval of it.
Supported by The New Outstanding Youth Program of Shanghai Municipal Health Bureau, No. XYQ2013090; the Shanghai Young Physician Training Program, the Zhuo-Xue Project of Fudan University; the Scientific Research Project supported by Huashan Hospital, Fudan University, No. 2013QD21; the National Natural Science Foundation of China, No. 81071884; Research Fund for the Doctoral Program of Higher Education of China, No. 20110071110065
Correspondence to: Feng Yang, MD, Pancreatic Disease Institute, Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai 200040, China. yffudan98@126.com
Telephone: +86-21-52887164 Fax: +86-21-52888277
Received: October 27, 2013
Revised: January 21, 2014
Accepted: March 12, 2014
Published online: November 14, 2014
Abstract

Pancreatic cancer is one of the most common gastrointestinal tumors, with its incidence staying at a high level in both the United States and China. However, the overall 5-year survival rate of pancreatic cancer is still extremely low. Surgery remains the only potential chance for long-term survival. Early diagnosis and precise staging are crucial to make proper clinical decision for surgery candidates. Despite advances in diagnostic technology such as computed tomography (CT) and endoscopic ultrasound, diagnosis, staging and monitoring of the metabolic response remain a challenge for this devastating disease. Positron emission tomography/CT (PET/CT), a relatively novel modality, combines metabolic detection with anatomic information. It has been widely used in oncology and achieves good results in breast cancer, lung cancer and lymphoma. Its utilization in pancreatic cancer has also been widely accepted. However, the value of PET/CT in pancreatic disease is still controversial. Will PET/CT change the treatment strategy for potential surgery candidates? What kind of patients benefits most from this exam? In this review, we focus on the utility of PET/CT in diagnosis, staging, and assessment of resectability of pancreatic cancer. In addition, its ability to monitor metabolic response and recurrence after treatment will be emphasis of discussion. We hope to provide answers to the questions above, which clinicians care most about.

Keywords: Position emission tomography/computed tomography, Pancreatic cancer, Diagnosis, Staging, Metabolic response

Core tip: Position emission tomography/computed tomography (PET/CT) is a useful modality in the detection of pancreatic cancer, while its use in staging is limited by the lack of enhanced CT scan and a relatively poor sensitivity in detecting metastatic lymph nodes. It has the advantage in monitoring metabolic response, making it optimal in evaluation of different kinds of treatment and also in detecting suspected recurrence. The correlation between Standardized Uptake Value and prognosis remains controversial. Many efforts have been made to improve the diagnostic efficacy of PET/CT.