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FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

2-(18F)-Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is an imaging technique which enables detection of malignancies. FDG-PET has been established as a tool for the diagnosis of pancreatic carcinoma (CA). Early detection is mandatory as cure can only be achieved in non-advanced disease. This is, however, very difficult with conventional radiological techniques. Patients with chronic pancreatitis (CP) are at risk of developing CA. A simple, reliable screening method for malignant degeneration is highly desirable. We set out to investigate whether FDG-PET is able to detect CA in the setting of CP and can fulfil a potential role in the early detection of CA in CP.

Methods

FDG-PET was performed in 77 CP patients and in six patients with CP complicated by CA (CP + CA). We included 26 CA patients as a positive control. A positive scan was defined as focal FDG accumulation in the pancreas region.

Results

In 67 of the 77 CP (87%) patients, pancreatic FDG accumulation was absent. Six patients had significant accumulation. In CA, 24/26 patients had a positive PET. Five out of the six patients with CP + CA had focal uptake, while minor uptake was seen in one patient. FDG-PET was positive in almost all CA patients and CP + CA patients. FDG-PET was negative in the large majority (87%) of CP patients, which suggests that a positive PET scan in CP patients must lead to efforts to exclude a malignancy.

Conclusion

These data suggest that FDG-PET has a potential role as a diagnostic tool for detecting CA in longstanding CP.

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References

  1. Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, et al. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 2000;25(2):213–6.

    Article  CAS  PubMed  Google Scholar 

  2. Witt H, Becker M. Genetics of chronic pancreatitis. J Pediatr Gastroenterol Nutr 2002;34(2):125–36.

    Article  CAS  PubMed  Google Scholar 

  3. Drenth JPH, te Morsche R, Jansen JBMJ. Mutations in serine protease inhibitor Kazal type 1 are strongly associated with chronic pancreatitis. Gut 2002;50(5):687–92.

    Article  CAS  PubMed  Google Scholar 

  4. Jansen JBMJ, Morsche RT, van Goor H, Drenth JPH. Genetic basis of chronic pancreatitis. Scand J Gastroenterol 2002;37:91–4.

    Article  CAS  Google Scholar 

  5. Steer ML, Waxman I, Freedman S. Medical progress—chronic pancreatitis. N Engl J Med 1995;332(22):1482–90.

    Article  CAS  PubMed  Google Scholar 

  6. Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK, Perrault J, et al. Hereditary pancreatitis and the risk of pancreatic cancer. J Nat Cancer Inst 1997;89(6):442–6.

    Article  CAS  PubMed  Google Scholar 

  7. Howes N, Lerch MM, Greenhalf W, Stocken DD, Ellis I, Simon P, et al. Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2004;2(3):252–61.

    CAS  PubMed  Google Scholar 

  8. Uehara H, Nakaizumi A, Baba M, Ishi H, Tatsuta M, Kitamura T, et al. Diagnosis of pancreatic cancer by K-ras point mutation and cytology of pancreatic juice. Am J Gastroenterol 1996;91(8):1616–21.

    CAS  PubMed  Google Scholar 

  9. Nakamura Y, Onda M, Uchida E. Analysis of K-ras codon 12 point mutations using duodenal lavage fluid for diagnosis of pancreatic carcinoma. Pancreas 1999;18(2):133–40.

    CAS  PubMed  Google Scholar 

  10. Boadas J, Mora J, Urgell E, Puig P, Roca M, Cusso X, et al. Clinical usefulness of K-ras gene mutation detection and cytology in pancreatic juice in the diagnosis and screening of pancreatic cancer. Eur J Gastroenterol Hepatol 2001;13(10):1153–9.

    Article  CAS  PubMed  Google Scholar 

  11. Gansauge S, Gansauge F, Negri G, Galle P, Muller J, Nussler AK, et al. The role of anti-p53-autoantibodies in pancreatic disorders. Int J Pancreatol 1996;19(3):171–8.

    CAS  PubMed  Google Scholar 

  12. Malesci A, Tommasini MA, Bonato C, Bocchia P, Bersani M, Zerbi A, et al. Determination of CA 19-9 antigen in serum and pancreatic juice for differential diagnosis of pancreatic adenocarcinoma from chronic pancreatitis. Gastroenterology 1987;92(1):60–7.

    CAS  PubMed  Google Scholar 

  13. Slesak B, Harlozinska-Szmyrka A, Knast W, Sedlaczek P, van Dalen A, Einarsson R. Tissue polypeptide specific antigen (TPS), a marker for differentiation between pancreatic carcinoma and chronic pancreatitis—a comparative study with CA 19-9. Cancer 2000;89(1):83–8.

    Article  CAS  PubMed  Google Scholar 

  14. Verlaan M, Te Morsche RHM, Roelofs HMJ, Laheij RJF, Jansen JBMJ, Peters WHM, et al. Genetic polymorphisms in alcohol-metabolizing enzymes and chronic pancreatitis. Alcohol Alcohol 2004;39(1):20–4.

    CAS  PubMed  Google Scholar 

  15. Friess H, Langhans J, Ebert M, Beger HG, Stollfuss J, Reske SN, et al. Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography. Gut 1995;36(5):771–7.

    CAS  PubMed  Google Scholar 

  16. Inokuma T, Tamaki N, Torizuka T, Magata Y, Fujii M, Yonekura Y, et al. Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US. Radiology 1995;195(2):345–52.

    CAS  PubMed  Google Scholar 

  17. Stollfuss JC, Glatting G, Friess H, Kocher F, Berger HG, Reske SN. 2-(Fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology 1995;195(2):339–44.

    CAS  PubMed  Google Scholar 

  18. Zimny M, Bares R, Fass J, Adam G, Cremerius U, Dohmen B, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med 1997;24(6):678–82.

    Article  CAS  PubMed  Google Scholar 

  19. Rose DM, Delbeke D, Beauchamp RD, Chapman WC, Sandler MP, Sharp KW, et al. 18Fluorodeoxyglucose-positron emission tomography in the management of patients with suspected pancreatic cancer. Ann Surg 1999;229(5):729–37.

    Article  CAS  PubMed  Google Scholar 

  20. Frohlich A, Diederichs CG, Staib L, Vogel J, Beger HG, Reske SN. Detection of liver metastases from pancreatic cancer using FDG-PET. J Nucl Med 1999;40(2):250–5.

    CAS  PubMed  Google Scholar 

  21. Imdahl A, Nitzsche E, Krautmann F, Hogerle S, Boos S, Einert A, et al. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg 1999;86(2):194–9.

    Article  CAS  PubMed  Google Scholar 

  22. Diederichs CG, Staib L, Vogel J, Glasbrenner B, Glatting G, Brambs HJ, et al. Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses. Pancreas 2000;20(2):109–16.

    Article  CAS  PubMed  Google Scholar 

  23. Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed 18F-fluoro-2-deoxy-D-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer 2000;89(12):2547–54.

    Article  CAS  PubMed  Google Scholar 

  24. Koyama K, Okamura T, Kawabe J, Nakata B, Chung KH, Ochi H, et al. Diagnostic usefulness of FDG-PET for pancreatic mass lesions. Ann Nucl Med 2001;15(3):217–24.

    CAS  PubMed  Google Scholar 

  25. Sperti C, Pasquali C, Chierichetti F, Liessi G, Ferlin G, Pedrazzoli S. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg 2001;234(5):675–80.

    Article  CAS  PubMed  Google Scholar 

  26. Papos M, Takacs T, Tron L, Farkas G, Ambrus E, Szakall S Jr, et al. The possible role of F-18 FDG positron emission tomography in the differential diagnosis of focal pancreatic lesions. Clin Nucl Med 2002;27(3):197–201.

    Article  PubMed  Google Scholar 

  27. Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, et al. Pancreatitis and the risk of pancreatic cancer. N Engl J Med 1993;328(20):1433–7.

    Article  CAS  PubMed  Google Scholar 

  28. Brentnall TA. Cancer surveillance of patients from familial pancreatic cancer kindreds. Med Clin North Am 2000;84(3):707.

    CAS  PubMed  Google Scholar 

  29. Wiersema MJ, Wiersema LM. Endosonography of the pancreas: normal variation versus changes of early chronic pancreatitis. Gastrointest Endosc Clin North Am 1995;5(3):487–96.

    CAS  Google Scholar 

  30. Lin EC, Studley M. Biliary tract FDG uptake secondary to stent placement. Clin Nucl Med 2003;28(4):318–19.

    Article  PubMed  Google Scholar 

  31. Hosten N, Lemke AJ, Wiedenmann B, Bohmig M, Rosewicz S. Combined imaging techniques for pancreatic cancer. Lancet 2000;356(9233):909–10.

    Article  CAS  PubMed  Google Scholar 

  32. Malesci A, Balzarini L, Chiti A, Lucignani G. Pancreatic cancer or chronic pancreatitis? An answer from PET/MRI image fusion. Eur J Nucl Med Mol Imaging 2004;31(9):1352.

    Article  PubMed  Google Scholar 

  33. Diederichs CG, Staib L, Glatting G, Beger HG, Reske SN. FDG-PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med 1998;39(6):1030–3.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, University Medical Center, St. Radboud, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Mariëtte CA van Kouwen, Jan B.M.J. Jansen & Joost P.H. Drenth

  2. Department of Surgery, University Medical Center, St. Radboud, Nijmegen, The Netherlands

    Harry van Goor

  3. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Steve de Castro

  4. Nuclear Medicine, University Medical Center, St. Radboud, Nijmegen, The Netherlands

    Wim J.G. Oyen

Authors
  1. Mariëtte CA van Kouwen
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  2. Jan B.M.J. Jansen
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  3. Harry van Goor
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  4. Steve de Castro
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  5. Wim J.G. Oyen
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  6. Joost P.H. Drenth
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Correspondence to Mariëtte CA van Kouwen.

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CA van Kouwen, M., Jansen, J.B., van Goor, H. et al. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging 32, 399–404 (2005). https://doi.org/10.1007/s00259-004-1689-4

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  • DOI: https://doi.org/10.1007/s00259-004-1689-4

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