Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma

Objective To evaluate the additional role of FDG-PET/CT to the conventional multiphasic CECT in the initial staging of pancreatic adenocarcinoma. Methods 54 patients diagnosed with pathologically proven pancreatic malignancy underwent FDG-PET/CECT. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal and metastatic staging were calculated. The statistical difference was calculated by McNemar's test. Results Of 54 patients, 15 had distal metastasis. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal staging were 33 vs 89%, 84 vs 100%, 67 vs 100%, 60 vs 90%, and 59 vs 95%, respectively, p < 0.001. The sensitivity, specificity, PPV, NPV, and accuracy of CECT for metastatic staging were 73, 87, 69, 89, and 83%, whereas the accuracy of PET/CT was 100%, p = 0.01. By correctly characterizing unsuspected distant lesions, PET/CT could change management in 19% of patients. Conclusion FDG-PET/CT can contribute to change in the management in almost one of every five patients of PA evaluated with the standard investigations during the initial staging.