Is Positron Emission Tomography Scanning changing the Management of Upper Gastrointestinal Malignancies?

Aims: Spiral CT is the current gold standard for staging hepatic, pancreatic and gastric malignancies, with gadolinium MRI also used to determine the resectability of hepatic tumours. As PET has more recently been used to identify patients with stage four disease, we wished to determine it's effect on the surgical management of hepatic, pancreatic and gastric malignancies.

Methods: Spiral CT and PET were obtained on 23 consecutive patients. Patients with hepatic malignancy also had MRI. The number of patients in whom PET altered surgical management was determined.

Results: 23 patients had PET in conjunction with spiral CT. 17 patients had resectable hepatic tumours as determined by CT and MRI – in 6 however PET demonstrated evidence of extra hepatic disease. PET altered the surgical management in 10 of 23 patients (43%), with one false negative.

MALIGNANGY	CT (no of patients)	PET (no of patients)	CHANGE IN MANAGEMENT (no of patients)	SURGERY (no of patients)	UNRESECTABLE AT SURGERY (no of patients)
LIVER	17	17	6	11	2
GASTRIC	4	4	3	1	1
PANCREATIC	2	2	1	1	0
TOTAL	23	23	10(43%)	13	3

Conclusion: PET scanning may well replace CT and MRI in the pre-operative assessment of upper gastrointestinal malignancies.