Guy M Raz, Benjamin E Johnson, Yusuf Menda, Sudershan K Bhatia, Anuradha R Bhama, James J Mezhir
Background Pancreatic ductal adenocarcinoma is an aggressive disease in which accurate staging is critical. Positron emission tomography has shown promise as a method of detecting metastatic disease in many cancers, but data supporting its use in pancreatic ductal adenocarcinoma is controversial. This study evaluated the impact of positron emission tomography on treatment in patients with pancreatic ductal adenocarcinoma. Methods A retrospective chart review identified patients with pancreatic ductal adenocarcinoma diagnosed between 2004-2012 who received positron emission tomography imaging as part of their disease assessment. The impact of positron emission tomography on therapy decisions was determined. Results Of the 62 patients evaluated, 7 (11.3%) had imaging prior to adjuvant therapy, 34 (54.8%) prior to neoadjuvant therapy, and 21 (33.9%) as part of initial staging. The median overall survival was 10.3 months (range: 1–31.6) and 14 patients (22.6%) underwent pancreatectomy. Positron emission tomography changed the treatment pathway in 6 patients (9.7%) including: 2/34 being staged prior to neoadjuvant therapy (5.9%) and 4/21 (19.0%) being evaluated with positron emission tomography as part of initial staging. There were 2 patients who had false positive findings resulting in unnecessary invasive testing. Conclusions In this study, Positron emission tomography imaging changed the treatment pathway in approximately 10% of patients with pancreatic ductal adenocarcinoma, primarily among patients with high risk clinical disease. The data suggests positron emission tomography imaging should be used selectively in patients with pancreatic ductal adenocarcinoma who have clinically advanced disease, where identification of distant disease would alter the patient’s treatment course.
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