Accuracy of Multi-Detector Computed Tomography, Fluorodeoxyglucose Positron Emission Tomography-CT, and CA 19-9 Levels in Detecting Recurrent Pancreatic Adenocarcinoma

摘要

Context We compared the accuracy of fluorodeoxyglucose positron emission tomography-CT(FDG-PET-CT), multi-detector computed tomography (MDCT) and CA 19-9 levels in detecting pancreatic cancer recurrencein patients with resected CA 19-9 positive pancreatic adenocarcinomas. MethodsWe retrospectively evaluated 122 patients with pancreatic adenocarcinomas who underwentsurgical resection of the tumor between January 2002 and December 2011. Twenty-fivepatients had MDCT, FDG-PET-CT and CA 19-9 levels performed no less than sixweeks post-operation andwithin 8 weeks of each other for detection of tumor recurrence. Of these, 20 patientshad high pre-operative CA 19-9 levels that dropped to a normal level postoperativelywhich will be the focus of this study. The sensitivity, specificity, positive andnegative predictive value (PPV, NPV), and accuracy of MDCT, FDG-PET-CT, and CA 19-9in detecting recurrence were compared. Results Operations performed includedpyloric sparing pancreaticoduodenectomy (n=9), pancreaticoduodenectomy (n=7), distalpancreatectomy (n=3) and total pancreatectomy (n=1). Three patients had no recurrence,but local recurrence and distant metastasis were seen in 8 (40%) and 12 (60%) patients,respectively. In our study, sensitivity, specificity, PPV, NPV and diagnosticeffectiveness (accuracy) were: 82%, 100%, 100%, 50%, 85% for MDCT; 82%, 100%, 100%,50%, 85% for FDG-PET-CT and 94%, 100%, 100%, 75%, 95%for CA 19-9. The difference in recurrence detection accuracy of the tests was notstatistically significant. A combination of CA 19-9 with MDCT or FDG-PET-CT was 100% accuratein detecting cancer recurrence in our patients. Conclusion Our data suggeststhat CA 19-9 levels can be used reliably to detect recurrent pancreatic adenocarcinomasin patients with CA 19-9-positive primary tumors. Combination of CA 19-9 with MDCT or FDG-PET-CT is potentiallythe most accurate approach in detecting pancreatic cancer recurrence.