18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer

J Am Coll Surg. 2008 Jan;206(1):57-65. doi: 10.1016/j.jamcollsurg.2007.07.002. Epub 2007 Oct 1.


Background: Although (18)F-fluorodeoxyglucose positron emission tomography (PET) has widespread clinical use, its role in cancers of the biliary tract is ill-defined. The aim of this study was to determine if preoperative PET provided additional staging information in patients with biliary tract cancer, beyond that obtained through conventional anatomic imaging. The role of PET in detecting disease recurrence after resection was also examined.

Study design: Between March 2001 and October 2003, 126 patients with biopsy-proved or presumed biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder carcinoma) underwent PET in addition to standard imaging evaluation. Histologic confirmation of the diagnosis was used as the reference standard with which PET results were compared. Patient followup information and serial imaging were reviewed for progression of lesions detected by PET.

Results: Of the 126 study patients, 93 (74%) underwent preoperative staging PET scans, the results of which changed the stage and treatment in 22 patients (24%): 15 of 62 (24%) with cholangiocarcinoma and 7 of 31 (23%) with gallbladder carcinoma. When used to assess for cancer recurrence (n=33), PET identified disease in 86% of patients but altered treatment in only 9%. So, of the entire study group, the findings of PET influenced management in 20% of patients (24% preoperative staging and 9% cancer recurrence). The sensitivity of PET for identifying the primary tumor was 80% overall: 78% for cholangiocarcinoma, 86% for gallbladder carcinoma.

Conclusions: Most biliary tract cancers are (18)F-fluorodeoxyglucose avid tumors. In patients with potentially resectable tumors based on conventional imaging, PET identified occult metastatic disease and changed management in nearly one-fourth of all patients. PET also helped confirm recurrent cancer after resection.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / diagnostic imaging*
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Intrahepatic*
  • Cholangiocarcinoma / diagnostic imaging*
  • Cholangiocarcinoma / surgery
  • Cholecystectomy / methods*
  • Diagnosis, Differential
  • Disease Progression
  • Female
  • Fluorodeoxyglucose F18*
  • Gallbladder Neoplasms / diagnostic imaging*
  • Gallbladder Neoplasms / surgery
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Positron-Emission Tomography / methods*
  • Prognosis
  • Radiopharmaceuticals


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18