Trial Information

Utility of [18F]-FDG PET Imaging to Distinguish Malignant From Benign Intrapapillary Mucinous Neoplasms

Intraductal papillary mucinous neoplasm (IPMN) is a cystic pancreatic neoplasm that is a
precursor to invasive pancreatic cancer. Differentiating whether an IPMN lesion is benign or
malignant is critical, as the prognosis and management differs drastically, varying from
surgical resection to observation. However, despite attempts to characterize features
concerning for malignancy, it is difficult to determine the likelihood of malignancy with
conventional imaging techniques, including CT, MRI, and EUS. An accurate, non-invasive test
to identify malignant IPMN is needed.

The investigators' hypothesis is that [18F]-FDG PET may be a superior modality for
differentiating between benign and malignant IPMN lesions. We are planning a prospective
pilot study of ten consecutive patients with IPMN from the Columbia University Pancreas
Center who are undergoing surgical resection for their disease. These patients will undergo
[18F]-FDG PET imaging, as well as CT, MRI, and EUS as clinically indicated. All scans will
be reviewed by two experienced nuclear medicine radiologists who will be blinded to the
clinical characteristics of study patients and who will reach a consensus. Areas of focally
increased [18F]-FDG intake will be identified. Side-by-side reading with CT scan will be
performed to evaluate whether the increased [18F]-FDG uptake corresponds to a pancreatic
lesion. Mean and maximal SUV values, as well as differences in intensity between the region
of interest and the remaining pancreas, will be calculated.Surgical pathology will be
utilized as the gold standard for histological determination. Standard post-operative
histological interpretation of each IPMN lesion will be recorded, including size, duct
involvement (main, side, or mixed), ductal dilatation, lesion location (head, neck, body,
tail), and histologic grade (adenoma, borderline, carcinoma in situ, invasive carcinoma). In
addition, any associated pancreatitis or any other non-IPMN neoplastic change will also be
noted.

Using PET scan results and surgical pathology information, we will evaluate the positive and
negative predictive values of [18F]-FDG PET for malignancy within IPMN lesions.