Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer

Table 1 Position emission tomography/computed tomography in detection of malignant pancreatic tumors

Ref.	Study design	Maligancy/all (n)	SUV (max) of malignant lesions (mean ± SD)	SUV (max) of benign lesions (mean ± SD)	Cutoff value	SE	SP	PPV	NPV	LR(+)	LR(-)	Accuracy
Keogan et al[24]	R	25/37	5.4	1.4	-	88.00%	83.33%	91.67%	76.92%	5.28	0.144	86.49%
1Rose et al[23]	R	52/65	5.0 ± 1.2	0.85 ± 0.1	-	92.30%	84.62%	96.00%	73.33%	6	0.09	90.76%
1Delbeke et al[22]	R	52/65	5.1 ± 2.6	0.85 ± 1.7	3.0	92.30%	84.62%	96.00%	73.33%	6	0.09	90.76%
2Lemke et al[20]	R	64/100	-	-	3.5	84.37%	61.11%	79.41%	68.75%	2.17	0.26	76.00%
1Lytras et al[18]	R	72/112	-	-	-3	73.00%	60.00%	80.00%	49.00%	-	-	64.00%
Heinrich et al[32]	P	46/59	-	-	-	89.13%	69.23%	91.11%	64.29%	2.89	0.16	84.75%
Nishiyama et al[31]	R	55/86	5.75 ± 2.69	3.69 ± 1.58	3.5	89.09%	70.97%	84.48%	78.57%	3.07	0.15	82.56%
Bang et al[30]	R	93/102	5.1 ± 2.1	3.2 ± 1.8	-	96.77%	77.78%	97.82%	70.00%	4.35	0.04	95.09%
Kauhanen et al[29]	P	19/38	4.85 ± 2.77	2.25 ± 0.75	2.6	85.00%	94.44%	94.44%	85.00%	15.3	0.16	89.47%
Buchs et al[28]	R	36/45	6.5 ± 4.5	3.4 ± 3.1	-	72.00%	33.30%	80.00%	25.00%	-	-	64.00%
4Buchs et al[28]	R	36/45	6.5 ± 4.5	3.4 ± 3.1	-	96.00%	66.60%	92.30%	80.00%	-	-	90.30%
Santhosh et al[27]	R	57/87	8.64 ± 5.21	4.86 ± 4.54	2.8	96.36%	78.57%	94.64%	84.61%	4.49	0.05	92.75%
Hu et al[26]	R	54/80	6.3 ± 2.4	2.9 ± 2.0	3.5	96.29%	72.72%	89.65%	88.89%	3.53	0.05	89.47%

¹Fluorodeoxyglucose-position emission tomography (FDG-PET) scan without computed tomography (CT);

²Voxel-based retrospective registration and fusion of CT and PET were performed with software. PET imaging and CT were not taken at the same time;

³Lesions measured visually;

⁴Data obtained with extra scan of enhanced PET/CT. SE: Sensitivity; SP: Specificity; NPV: Negative predictive value; PPV: Positive predictive value; R: Retrospective study; P: Prospective study.

Table 2 Position emission tomography/computed tomography in differential diagnosis of pancreatic carcinoma and mass-forming pancreatitis

Ref.1	Study design	PC/CP	SUV(max) of PC	SUV(max) of CP	Cutoff value	SE	SP	PPV	NPV	LR(+)	LR(-)	Accuracy
			(mean ± SD)	(mean ± SD)
Stollfuss et al[25]	R	43/30	3.16 ± 1.22	1.00 ± 0.55	1.53	93.18%	93.10%	95.35%	90.00%	13.51	0.07	93.15%
Mertz et al[21]	R	31/4	-	-	2.80	87.09%	50.00%	93.33%	33.33%	1.74	0.25	82.86%
van Kouwen et al[19]	R	32/77	-	-	-2	90.62%	87.01%	74.35%	95.71%	6.97	0.11	88.07%
Lytras et al[18]	R	54/25	-	-	-3	78.00%	55.00%	78.00%	55.00%	-	-	64.00%

¹Fluorodeoxyglucose-position emission tomography (FDG-PET) scan without computed tomography (CT);

²Results were judged to be abnormal if focal accumulation of the tracer was detected in the area of the pancreas. Faint and/or diffuse FDG uptake in the pancreatic region (i.e., uptake slightly higher than the surrounding background, but clearly lower than the liver) was not considered suspicious for pancreatic cancer;

³Lesions measured visually. SE: Sensitivity; SP: Specificity; NPV: Negative predictive value; PPV: Positive predictive value; R: Retrospective study; P: Prospective study.

Table 3 ¹⁸F-fluorodeoxyglucose-position emission tomography/computed tomography in N-staging and detection of liver metastasis of pancreatic cancer

Ref.	Study design	SE (%) (true positive/total positive)
		PET/CT	CT	P value
N-staging
Heinrich et al[32]	P	21.42 (3/14)	-	-
Maemura et al[59]	R	50.00 (3/6)	66.67 (4/6)	0.56
1Wakabayashi et al[51]	P	57.10 (8/14)	78.6 (11/14)	0.42
Kauhanen et al[29]	P	38	-	-
1Imai et al[60]	R	0 (0/6)	0 (0/6)
Detection of liver metastasis
Fröhlich et al[63]	R	68 (15/22)
Mertz et al[21]	R	78 (7/9)	33.33 (3/9)	0.06
Lytras et al[18]	R	22	20	0.81
Heinrich et al[32]	P	81 (13/16)	56 (9/16)	0.22
Maemura et al[59]	R	37.5 (3/8)	87.5 (7/8)	0.04
Wakabayashi et al[51]	P	52.6 (10/19)	73.7 (14/19)	0.18
Farma et al[62]	R	61	57
Strobel et al[52]	R	46 (5/11)
Kauhanen et al[29]	P	88(6/7)	42.86 (3/7)	0.09

¹¹⁸F-fluorodeoxyglucose-position emission tomography (FDG-PET) scan without computed tomography (CT). SE: Sensitivity; SP: Specificity; NPV: Negative predictive value; PPV: Positive predictive value; R: Retrospective study; P: Prospective study.