The Role of 18-FDG PET/CT Combined with CA 19-9 in the Diagnosis of Early-Stage Pancreatic Adenocarcinoma: A Systematic Review and Meta-analysis.

Conclusions: There has been no study evaluating the use of 18-FDG PET/CT in tandem with CA 19-9 to diagnose early stage pancreatic adenocarcinoma. Using the same principles previously applied to HIV diagnosis where a sensitive and relatively less expensive screening blood test (i.e., ELISA) would be used in tandem with a specific but more expensive confirmatory test (i.e., Western blot), it is proposed that early-stage pancreatic adenocarcinoma may be diagnosed in tandem similarly. When the threshold for CA 19-9 is lowered to 32 units/mL, the blood test can be used as a screening test for pancreatic adenocarcinoma since the sensitivity can reach 95%. This methodology will increase the pre-test probability for the confirmatory test 18-FDG PET/CT, which is admittedly more expensive and more risky from radiation exposure. If confirmed by 18-FDG PET/CT, the patient may then undergo more invasive tests such as ultrasound-guided endoscopic biopsy or endoscopic retrograde cholangiopancreatogram. It is hoped that this new paradigm will allow very early detection of pancreatic adenocarcinoma when complete cure is more likely achievable. A randomized double-blind clinical study will be needed to confirm this proposal.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: GI & amp;acirc; amp;euro; ' Pancreatic amp; Neuroendocrine Source Type: research