The role of fusion positron emission tomography/computed tomography (PET/CT) scan in patients with resectable pancreatic neoplasms.

322 Background: The role of fusion positron emission tomography/computed tomography scans (PET/CT) in staging of patients with pancreatic neoplasms (PN) is poorly defined. Currently PET/CT is not recommended as part of staging workup in patients with potentially resectable PN. Methods: Using a comprehensive cancer PET registry we identified 107 patients with PN who were potentially resectable based on the initial preoperative staging CT scans and endoscopic ultrasound (EUS), from January 2006 - December 2010. Subsequently all these patients had PET/CT performed prior to surgery. Patients with borderline resectable or locally advanced disease were excluded from the analysis. Statistical analyses were performed included sensitivity, specificity, positive predictive value, and negative predictive value. Statistical analyses were performed with STATA IC (Stata Statistical Software, Release 10.0; Strata Corp., College Station, TX). Results: PET/CT altered management and prevented futile surgery in 6.5 % patients by identifying metastases not detected by other modalities. One patient was found to have metastasis to the supraclavicular lymph node, five had occult hepatic lesions and another had peri-esophageal lymph nodes. All sites were biopsied and metastases confirmed by pathology. The sensitivity and specificity of PET/CT scan in detecting metastatic disease in this patient population was 42.1% and 83.3% respectively. Our study indicated a positive predictive value of PET/CT to be 40% and negative predictive value 84.5%, with a false positive rate of 16.6%. Conclusions: PET/CT was instrumental in preventing futile laprotomy in 6.5 % patients. Larger studies utilizing PET/CT in the initial preoperative staging workup are warranted.