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Oncology-Clinical Diagnosis: Solid TumorsGI Cancers - Esophagus, Gastric and Pancreas |
1 Nuclear Medicine; 2 Internal Medicine II; 3 Radiology; 4 Medical Statistics; 5 Surgery, TU Munich, Munich, Germany
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Objectives: We have determined the ability of positron emission tomography (PET) with the thymidine analog 3`-deoxy-3`[18F]fluorothymidine (FLT) to detect pancreatic cancer and to differentiate malignant from benign pancreatic masses.
Methods: In this prospective study, FLT-PET was performed in 31 patients with pancreatic tumors suspicious for malignancy. Routine diagnostic procedures included US, endoscopic US, MRI and/or contrast enhanced spiral CT of the upper GI tract in all patients. 45-60 min after i.v.-injection of approx. 370 MBq FLT, emission and transmission scanning was performed using a high resolution PET scanner. Tracer uptake in the tumor and normal organs was evaluated semiquantitatively by calculation of mean and max FLT-SUV. Results were correlated to histopathology and clinical follow-up.
Results: All benign pancreatic tumors were negative at FLT-PET and showed only background activity (specificity 100%). Fourteen of 19 malignant tumors showed focal FLT-uptake higher than surrounding background (sensitivity 74%). FLT-PET missed four adenocarcinomas and a cystadenocarcinoma. Mean FLT-uptake in all malignant tumors was 3.3 (range, 1.3-8.5), in tumors with visual FLT-uptake 3.8 (range, 2.1-8.5) and significantly higher compared to benign tumors (1.4, range, 1.2-1.7; p<0.001).
Conclusions: In this pilot study, focal uptake of the in-vivo proliferation marker FLT was exclusively detected in malignant tumors of the pancreas. We therefore conclude that FLT-PET may represent an appropriate tool to differentiate pancreatic cancer from pancreatic pseudotumors.
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