Does performing a PET scan improve our ability to diagnose pancreatic cancer and identify unresectable disease?

Does performing a PET scan improve our ability to diagnose pancreatic cancer and identify unresectable disease?

in the Table. Consideringthe best cut-off point, both the diagnostic sensitivity and specificity of Tu M2-PK for pancreatic cancer were 74%, while tho...

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in the Table. Consideringthe best cut-off point, both the diagnostic sensitivity and specificity of Tu M2-PK for pancreatic cancer were 74%, while those of CA 19-9 were 70% and 93%, respectively.The combination of the two tests significantly increasedsensitivity (92%), with a specificity of 70%. Analysis of the ROC curves did not show any significant difference between Tu M2-PK and CA 19-9. Cholestasis did not affect the values of Tu M2-PK, while CA 19-9 was significantly higher in patients with this condition. In conclusion, Tu M2-PK is a promising marker in the diagnosis of pancreatic cancer and is complementaryto CA 19-9 in patients with jaundice. Group

Median (U/ml)

10-90~ percentile

Significancevs PC

PC BPD PCT NET OGM BDD HC

16.4 11.5 5.6 35.1 18.0 5.8 4.4

2.7 - 117.2 3.0 - 73.4 3.4-18.8 4.0 - 193.2 3.0 - 174.6 1.9 - 21.8 1.8-10.5

-NS NS NS NS P<0.001 P<0.001

CONCLUSIONS: This ongoing prospective study suggests that by reversing the effect of meperidine, naloxone may increase the detection rate of colon VEs and other GI vascular lesions in pts receiving meperidine.The 3-fold difference noted betweenthe two groups did not reach statistical significance, perhaps becauseof our small group sizes.

4104 Does Performing a PET Scan Improve Our Ability to Diagnose Pancreatic Cancer and Identity Unresectable Disease? All Fazel,James F. GIockner, Isin Akduman, Laurie A. Martin, James W. Fletcher, Frank R. Burton, Saint Louis Univ, St. Louis, MO

Background: The most commonly used imaging modality to diagnose and stage pancreatic cancer (PCa) is the CT scan. It has been proposed that additional information provided by PETscanning allows more accuratediagnosis and staging. We sought to comparethe performance of combinationnon-attenuationcorrectedFDG-PET/CTto that of CTalonefor diagnosing the presenceand resectabilityof PCa.Methods:All patientspresentedwith signs and symptoms consistent with PCa. Contrast CT of the abdomen and whole body non-attenuationcorrected PET studies (45-60 min post injection of 0.14 mCi/Kg of 18-fluorodeoxyglucose)were performed in all subjects. Imageswere reviewedby two independentobserverswho were blinded to clinical information and other imaging resp~. Readerswere required to indicate whether the findings were consistent with PCa. The imaging data was also used for staging to dichotomize between resectableand non-resectablePCa.The diagnosis of cancer was based on biopsy results and resectabilitywas determinedby operativefindings at exploratory laparotomy or by biopsy confirmation of a metastatic lesion. Results: 28 patients were studied. 16 patients had PCa (12 unresectable,4 resectable)while 12 had benign disease.The sensitivity, specificity, positive predictive value and negative predictive value of both methods were obtained. There was no significant improvement in diagnostic performancewith the addition of non-attenuationcorrected PET to the standard CT scan(p>.20). Diagnostic performances are shown in the table below. Conclusion: The addition of non-attenuation corrected PET scanning to the standard CT scan did not significantly increase diagnostic performance in the detection of PCa or in the identification of unresectabledisease.

CT CT and PET

Diagnosisof PancreaticCancer Sens Spec PPV

87% 94%

50% 45%

70% 73%

NPV

Diagnosisof UnresectablePCa Sens Spec PPV

NPV

75% 83%

83% 91%

60% 67%

75% 50%

91% 85%

Sens=sensitivity,Spec=specificity,PPV=positivepredictivevalue,NPV=nega~vepredictivevalue 4240 A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Effects of Meperldine and Naloxone on the Diagnosis of Vascular Ectasias (VEs) Edna Khodadadian,Winthrop Univ Hosp, Mineola, NY; Hazar Michael, Montefiore Medical Ctr, Bronx, NY; Pankaj Patel, James Chou, Winthrop Univ Hosp, Mineola, NY; Lawrence 8randt, Montetiore Medical Ctr, Bronx, NY; Frank G. Grass, Winthrop Univ Hosp, Mineola, NY

BACKGROUND:VEsare an important cause of GI bleeding in the elderly. VEs can be missed because of low blood pressure, blood volume & anemia. Also, it has been shown that meperidinemay maskvascularlesionsand naloxonecan reversethese maskingeffects.OBJECTIVE: A randomized,double-blind, placebo-controlledstudy to evaluatethe effects of meperidine & naloxoneon the appearanceof VEs. METHODS:All adults having endoscopyfor anemia (16), overt (8) & occult(9) GI bleeding or history of VEs (5) were eligible to be enrolled. Pregnancy,active bleeding & allergy to meperidineor naloxoneprompted exclusion. Standard doses of meperidine & midazolamwere given before endoscopy. Number, location & size of all VEs seenwere recorded.Pts werethen randomizedto receiveeither naloxone(0.4mg = lcc) or normal saline(1 cc). After 1 minute the stomach, duodenum (EGD) & the colon proximal to the splenic flexure (colonoscopy) were re-evaluated.The number, location, & size of VEs were recorded again. Blood pressure, MAP, heart rate, 02 saturation were monitored every 5 minutes during the procedure and for 2 hours. Datawere analyzedusing Fisher's ExactTest. RESULTS:22 pts were enrolled (9 F/13 M, mean age = 67, range 34-90 yrs.). Pts received 25-100 mg meperidineand 1-10 mg midazolam during the procedure. Endoscopyincluded: colonoscopy (14), EGD (7), enteroscopy (1). Before study medications, 27 VEs were seen in 6 pta at colonoscopy (1 IC valve,12 cecal,14ascendingcolon)and vascular lesions were seen in 2 pts at EGD (1 gastric body, 1 duod.). New VEs were seen in 4 pts at colonoscopy: 3 (27%) pts in the naloxonegroup & 1 pt (9%)in the saline group (p =0.58). 6 new VEs were seen in the cecum (3) and asc. colon (3). All 4 pts with new VEs had an increasedBP->IOmmHG after study reeds and a Hgb
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