Diagnostic Usefulness of PET/CT for Pancreatic Malignancy / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to evaluate the diagnostic usefulness of PET/CT for pancreatic malignancy. METHODS: We retrospectively analyzed medical records of 115 patients with pathologically diagnosed pancreatic cancer between January 2003 to August 2008 who underwent abdominal CT and PET/CT examination before histological confirmation. CT and PET/CT images were reviewed in single-blinded status and diagnostic ability on primary pancreatic lesion, regional lymph node metastasis, and distant metastasis was evaluated. RESULTS: 99 patients (86%) had malignant diseases including 91 cases of adenocarcinoma, and 16 patients (14%) benign diseases. Only CA 19-9 value and SUV were significantly different between PET/CT positive and negative groups (p=0.001, p<0.001). Sensitivity, specificity and positive predictive values (PPV) of both modality for pancreatic lesion were same (94%, 62%, and 95%, respectively), and negative predictive values (NPV) were 67% on CT and 57% on PET/CT. PET/CT correctly diagnosed 8 cases (6.9%) of falsely diagnosed pancreatic lesion on CT. Nine cases (15.7%) of misdiagnosed lymph node metastasis on CT were correctly diagnosed on PET/CT. But, there was no significant difference in the diagnosis of regional lymph node metastasis. 3 out of 29 cases of distant metastasis, except 2 cases of supraclavicular lymph node metastasis, were additionally diagnosed by PET/CT. But, overall sensitivity of distant metastasis was significantly higher in CT (83% vs 69%, p=0.045). CONCLUSIONS: Although PET/CT provided additional correct diagnoses in many cases, it showed fair diagnostic power for primary pancreatic lesion and lymph node metastasis, and lower sensitivity for distant metastasis. Therefore, PET/CT should be used as an supplementary modality of CT in diagnosing pancreatic malignancy.

A case of adenomyoma in distal common bile duct / 대한내과학회지

Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the extrahepatic bile duct. To the best of our knowledge, it is a completely benign lesion, but making a clear distinction from malignancy on preoperative evaluation is very difficult. Its clinical importance mainly lies in the possibility that they may be confused with carcinoma, leading to unnecessarily extensive surgical resections. We report here on a case of distal common bile duct adenomyoma that presented with right upper quadrant abdominal pain, and the preoperative examinations could not reveal whether the tumor was benign or malignant. It was finally diagnosed by histological examination after performing pylorus preserving pancreaticoduodenectomy.