The impact of FDG-PET/CT on the diagnostic pathway of surgically treated pancreatic ductal adenocarcinoma: the Surg-Panc-UK study.

BACKGROUND: In the UK, NICE recommends FDG-PET/CT (PET/CT) in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) though the impact upon the patient pathway is unclear and was not tested in the PETPANC study.

METHODS: National retrospective observational cohort study of consecutive patients undergoing surgery for PDAC. The primary outcome was the difference in diagnostic pathway length with and without a PET/CT. Secondary outcomes determined differences in investigations, resection rates and survival one year after surgery.

RESULTS: Of 830 patients included, 26.5% underwent PET/CT, associated with a significantly longer diagnostic pathway (median 20.5 additional days). PET/CT was associated with more multidisciplinary meetings and investigations, but did not alter resectability rates (90.3% vs 89.1%, PET/CT vs no PET/CT; p = .600), or facilitate operating on patients with more borderline disease (vascular resection 15.1% vs 13.6% PET/CT vs no PET/CT; p = .651). There was no difference in intra-operative unresectability or 12-month survival. There was an increase in MRI use after implementation of the guidelines among patients not undergoing PET/CT, suggesting teams developed different staging strategies.

CONCLUSION: This national study demonstrates patients undergoing a PET/CT experience a diagnostic pathway that is one third longer, with more investigations, without a difference in resectability rates or survival.