18F‐FDG PET/CT influences management in patients with known or suspected pancreatic cancer

Background: The aims of this study were (i) to assess and validate the incremental information of positron emission tomography/computed tomography (PET/CT) over conventional staging investigations (CSI) and (ii) to assess the management impact of PET/CT in patients with known or suspected pancreatic cancer. Methods: Between October 2007 and September 2008, 22 PET/CT scans were performed using a dedicated PET/CT scanner in 21 patients with known or suspected pancreatic cancer. Follow up was used to reconcile discordance between PET/CT and CSI. The pre‐PET/CT management plan and/or intent were prospectively recorded in all scans. The post‐PET/CT management plan was determined from the medical record and/or discussions with treating clinicians. The management impact of PET/CT was classified as high, medium, low or none defined using Australian and New Zealand Association of Physicians in Nuclear Medicine PET data collection project criteria. Results: PET/CT and CSI were discordant in 14/22 (64%: 95% CI; 43–84%) scans. Of the 14 discordant scans, PET/CT assessment was correct in eight, conventional imaging in four and there was insufficient information in two. Overall, PET/CT management impact was classified as high (n= 6), medium (n= 3), low (n= 9) or none (n= 4). Significant changes in management (high or medium impact) were induced by PET/CT in 9/22 scans (41%: 95% CI; 20–62%) predominantly by correctly modifying the disease extent. Conclusion: PET/CT has an incremental benefit over CSI and has a significant impact on management in patients with known or suspected pancreatic cancer. PET/CT merits consideration as part of the non‐invasive evaluation of patients with known or suspected pancreatic cancer.