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FLT PET/CT Is Better Than FDG PET/CT in Differentiating Benign From Malignant Pancreatobiliary Lesions
P M Vineeth Kumar1, G R Verma, B R Mittal
1From the Departments of *General Surgery, †Nuclear Medicine, ‡Gastroenterology, and §Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Purpose:
F-fluorothymidine (FLT), unlike FDG, is incorporated exclusively into DNA and is considered a specific marker of cell proliferation. The role of FLT PET/CT scan in differentiating benign from malignant pancreatobiliary tumors is unknown.
Patients And Methods:
Twenty-five suspected pancreatobiliary tumors on contrast-enhanced CT (CECT) scan in 23 patients were evaluated by FDG PET/CT and FLT PET/CT scans. The histopathology or fine-needle aspiration cytology was considered as criterion standard for the diagnosis. Surgeons were blinded to FLT PET/CT results. Management decision was guided by clinical and CECT scan and FDG PET/CT.
Results:
Five of 23 patients had metastatic disease on CECT imaging. The remaining 18 underwent exploratory laparotomy. Two of them had synchronous lesions. Histopathology/fine-needle aspiration cytology confirmed malignancy in 17 lesions and benign disease in the remaining 8 lesions. All 8 benign lesions were negative on FLT PET/CT. Seven of the 8 benign lesions were clinically diagnosed as malignancy on CECT and FDG PET/CT. The specificity, positive predictive value, and accuracy were higher for FLT PET/CT (100%, 100%, and 92%) compared with CECT (12.5%, 70.83%, and 72%) and FDG PET/CT (12.50%, 69.57%, and 68%). However, the sensitivity of FLT PET/CT (88.24%) was similar to CECT (100%) and FDG PET/CT (94.12%).
Conclusions:
Molecular-based FLT PET/CT is a better imaging than FDG PET/CT in differentiating benign from malignant lesions in the pancreatobiliary region. It has a potential to bring down the incidence of preventable radical resection in suspected pancreatobiliary tumors.
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