Prognostic importance of standardized uptake value on F-18 fluorodeoxyglucose-positron emission tomography in biliary tract carcinoma.

BACKGROUND AND OBJECTIVES: F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) has been used for diagnosis and staging of malignant diseases. However, the prognostic significance of FDG uptake on PET had not been sufficiently evaluated in patients with biliary carcinoma. METHODS: We performed a retrospective review of patients with biliary carcinoma imaged by FDG-PET to determine whether high uptake of FDG predicted overall survival independently of clinicopathological characteristics. Sixty-nine patients with biliary carcinoma underwent FDG-PET before cancer treatment. The maximum standard uptake value (maxSUV) was calculated as an index of FDG uptake. RESULTS: A receiver operating characteristic curve demonstrated a maxSUV of 6.3 to be the optimal cutoff point. The 3-year survival rate of patients with a maxSUV of 6.3 or less was 74.3%, whereas it was 44.1% for those with values greater than 6.3. Univariate analysis showed that the maxSUV was one of the significant prognostic factors for overall survival (P = 0.0119), whereas multivariate analysis showed that the independent predictors of survival were pN, pM, and pTNM staging. CONCLUSIONS: SUV analysis of FDG-PET was useful to predict the prognosis of biliary carcinoma. This information may assist in the guiding of treatment strategies before postoperative pathological assessment.

Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology.

The aim of this study was to evaluate the value of positron emission tomography with (18)F-labeled fluorodeoxyglucose (FDG-PET) as a preoperative diagnostic investigation in patients with biliary carcinoma. Seventy-two patients with potentially resectable biliary carcinoma underwent preoperative multidetector-row computed tomography (MDCT) and FDG-PET. Both diagnoses were compared with subsequent histopathology and follow-up results. In 64 lesions with biliary carcinoma, 57 (89%) revealed an intense focal accumulation on FDG-PET and were interpreted as malignant. On the other hand, eight benign lesions did not show any specific accumulation. Detection rate of FDG-PET in the nodular type of the tumour (96% or 27/28) was superior to that of the infiltrating type (74% or 17/23) (p = 0.037). For the evaluation of lymph node metastasis, the overall accuracy was 69% (35/51) in both FDG-PET and MDCT: FDG-PET had a lower sensitivity (33% vs. 57%) and a higher specificity (97% vs. 79%) than MDCT, although the values were not significantly different. FDG-PET revealed all six lesions of distant metastases in six patients including two lesions missed by MDCT. FDG-PET has high detectability of biliary malignancies. Like MDCT, FDG-PET offers only modest accuracy for regional lymph node staging, but it may reveal distant metastases missed by MDCT.

[Adjuvant chemotherapy for unresectable locally advanced pancreatic cancer in light of its characteristics].

The use of neoadjuvant chemotherapy for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors, especially for patients with Stage IV b (Japan criteria). We report our experience with a six-drug chemotherapeutic regimen that resulted in sufficient downstaging of the tumor in some patients to justify surgical resection. From Jan. 2001 through December 2003, 6 patients received 5-FU as a continuous infusion (200 mg/m2/day), calcium leucovorin weekly by intravenous bolus injection (30 mg/m2), mitomycin-C every 6 weeks (10 mg/m2 intravenously), and dipyridamole daily orally (75 mg), according to the UCLA regimen and gemcitabine weekly (600 mg/m2) and heparin as a continuous infusion (0-3,000 U/day) for locally advanced unresected pancreatic cancer. All of these patients were evaluable for response and survival. There were 5 partial responses (83% response rate) and 1 no response. Four of 5 responding patients had sufficient tumor regression to meet clinical criteria for resectability, three of whom underwent a curative resection. All patients who underwent downstage operation were still alive for the follow-up period (4-23 months).