235P - Clinical Utility of PET/CT and Diagnostic Laparoscopy in Pancreatic Cancer Staging (235P)

Date 18 November 2017
Event ESMO Asia 2017 Congress
Session Poster lunch
Topics Pancreatic Cancer
Gastrointestinal Cancers
Imaging, Diagnosis and Staging
Presenter Ajaz Bulbul
Citation Annals of Oncology (2017) 28 (suppl_10): x57-x76. 10.1093/annonc/mdx660
Authors A. Bulbul1, A. Mustafa2, S. Chouial1, S. Rashad1, S. Gholam3, E.A. Mino1, H. Aboud4, M. Khorsand1
  • 1Hematology/oncology, Kymera Cancer Center-Carlsbad, 88220 - Carlsbad/US
  • 2Anesthesiology, Acharya Shri Chander College of Medical Sciences, 48109 - Jammu/IN
  • 3Palliative Care Medicine, University of Southern California Norris Comprehensive Cancer Center, 90089 - LOS ANGELES/US
  • 4Internal Medicine, Cardiology, university of michgan ann arbor, 48109 - michigan/US



The current role FDG-PET/CT and staging diagnostic laparoscopy (SDL) in clinical practice is still evolving. We aimed to see how the use of these modalities may affect clinical practice management of pancreatic cancer patients.


A retrospective study of 74 patients across three rural practices with new diagnoses of pancreatic cancer were evaluated. Patients that had PET/CT, MRI with contrast and SDL in addition to initial diagnostic modalities were identified and diagnostic utility determined using descriptive statistics


Patients were in age range (49-89 years). The most common initial diagnostic imaging modality used was CT with contrast 92% (68/74). Diagnostic histologic modalities used were: CT guided biopsy 27/74, EUS biopsy 28/74, Diagnostic laparoscopy 14/74, ERCP 4/74 and 1/74 cases with paracentesis. Five percent (4/74) were stage 1 at diagnosis; 55% (41/74) stage 2 (2A, 2B); 19% (14/74) stage 3 and 19% (14/74) stage 4. Twenty-five percent (17/68) had PET/CT and 25% (17/68) underwent MRI scan for staging in addition to initial diagnostic imaging modality. PET/CT scan led to stage migration vs. CT in 47% (8/17). Two patients (11.8%) had stage migration when MRI was added to a CT scan. All additional disease detected on PET/CT scan was in the liver. Staging diagnostic laparoscopy (SDL) led to stage migration in 37.5% (6/16) patients all of whom were >3 cm (at least Stage 2B) with most common site being the peritoneum which was not detected on CT, MRI or PET/CT.


For patients deemed resectable after standard staging PET/CT could detect additional disease in the liver thereby helping avoid unnecessary surgical costs and morbidity. Detection of peritoneal implants remains challenging with CT and PET/CT and diagnostic laparoscopy may be of benefit in selected high-risk cases based on tumor size and stage

Clinical trial identification

Legal entity responsible for the study

Kymera Independent Physicians




All authors have declared no conflicts of interest.