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.