For people with suspected pancreatic cancer, the addition of a specialist scan provides more accurate diagnosis and can better determine the stage of cancer, avoiding unnecessary surgery, research led by the University of Liverpool has found.
The PET-PANC trial is the first of its kind to examine diagnosis of pancreatic cancer with PET-CT (positron emission tomography-computed tomography) and its findings have informed the latest NICE Guideline on the diagnosis and management of pancreatic cancer.
There are more than 9,000 new cases of pancreatic cancer diagnosed each year in the UK. Surgery to remove the cancer is the only potential cure, however this is not possible if, as in the large majority of cases, the cancer has already spread at the time of diagnosis or is inoperable. Therefore, it is vital that the stage of the disease is accurately determined, so patients are not subjected to surgery that will not benefit them.
Researchers recruited 550-patients from 18 centres across the UK with suspected pancreatic cancer who underwent a standard diagnostic workup, including multidetector computed tomography (MDCT) and a multidisciplinary team workup. Eligible patients underwent informed consent and a PET-CT within two weeks.
Chief Investigator Dr Paula Ghaneh, from the University’s Institute of Translational Medicine said: “Using PET-CT corrected the staging in patients with pancreatic cancer, influenced management in 45% of patients and prevented futile resection in (20%) patients due to have surgery. Our results could have a significant impact on the diagnosis and management of pancreatic cancer by improving the staging and management of the disease. Ensuring that patients are not subjected to unnecessary surgery and giving them earlier access to chemotherapy.”
The team found that in a patient with a positive CT scan, a positive PET-CT increased the odds of having pancreatic cancer by 55% and a negative PET-CT decreased the odds of having pancreatic cancer by 95%. In a patient with a negative CT, a positive PET-CT increased the odds of having pancreatic cancer by 538% and a negative PET-CT decreased the odds by 46%.
PET-CT corrected staging in 14% of patients, with the majority of these being tumours that were upstaged to either a stage 2B or a stage 4. The analysis also showed using PET-CT would be cost-effective for the NHS.
The research was funded and published by the National Institute for Health Research (NIHR).
The full results have published in Health Technology Assessment within the NIHR Journals Library [https://doi.org/10.3310/hta22070]
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