A pilot study of the diagnostic and prognostic values of FLT-PET/CT for pancreatic cancer: comparison with FDG-PET/CT

• Published in: Abdominal imaging 2017-04, Vol.42 (4), p.1210-1221
• Main Authors: Nakajo, Masatoyo, Kajiya, Yoriko, Tani, Atsushi, Jinguji, Megumi, Nakajo, Masayuki, Nihara, Tohru, Fukukura, Yoshihiko, Yoshiura, Takashi
• Format: Article
• Language: English
• Subjects: Aged; Dideoxynucleosides; Female; Fluorodeoxyglucose F18; Gastroenterology; Hepatology; Humans; Imaging; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Metastasis - diagnostic imaging; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pilot Projects; Positron Emission Tomography Computed Tomography - methods; Prognosis; Radiology; Radiopharmaceuticals; Sensitivity and Specificity; Survival Rate
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-016-0987-1

Purpose The purpose of the study was to examine the diagnostic and prognostic values of 18 F-fluorothymidine (FLT)-PET/CT for pancreatic cancer by comparing with 18 F-fluorodeoxyglucose (FDG)-PET/CT. Methods Fifteen patients with newly diagnosed pancreatic cancer underwent both FLT and FDG-PET/CT scans before treatment. The sensitivity, specificity, and accuracy in detecting nodal and distant metastases were compared between both scans using McNemar exact or χ 2 test. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic significance was assessed by Cox proportional hazards analysis. Results Both scans visualized all primary cancers. The sensitivity, specificity, and accuracy per patient basis for detecting nodal metastasis were equal and 63.6% (7/11), 100% (4/4), and 73.3% (11/15) for both scans, and for detecting distant metastasis were 100% (6/6), 88.9% (8/9), and 93.3% (14/15) for FDG-PET/CT, and 50.0% (3/6), 100% (9/9), and 80.0% (12/15) for FLT-PET/CT, respectively, without significant difference in each of them between both scans ( p  > 0.05). However, of 4 patients with multiple liver metastases, FDG-PET/CT was positive in all, but FLT-PET/CT was negative in three patients. At univariate analysis, only FLT-SUV max correlated with PFS (hazard ratio, 1.306, p  = 0.048), and FDG total lesion glycolysis (TLG), FLT-SUV max , and FLT-total lesion proliferation (TLP) correlated with OS ( p  = 0.021, p  = 0.005, and p  = 0.022, respectively). At bivariate analysis, FLT-SUV max was superior to FDG-TLG or FLT-TLP for prediction of OS [HR (adjusted for FDG-TLG), 1.491, p  = 0.034, HR (adjusted for FLT-TLP), 1.542, p  = 0.023]. Conclusion FLT-PET/CT may have a potential equivalent to FDG-PET/CT for detecting primary and metastatic cancers except liver metastasis. FLT-SUV max can provide the most significant prognostic information.