Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT

  • Pei-Ju Chuang (Department of Nuclear Medicine, National Taiwan University Hospital) ;
  • Hsiu-Po Wang (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yu-Wen Tien (Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Wei-Shan Chin (School of Nursing, National Taiwan University College of Medicine) ;
  • Min-Shu Hsieh (Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Chieh-Chang Chen (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Tzu-Chan Hong (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Chi-Lun Ko (Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yen-Wen Wu (School of Medicine, College of Medicine, National Yang Ming Chiao Tung University) ;
  • Mei-Fang Cheng (Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine)
  • Received : 2023.03.31
  • Accepted : 2023.12.31
  • Published : 2024.03.01
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Abstract

Objective: We aimed to investigate whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[18F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

Keywords

Acknowledgement

The authors thank the Center of Statistical Consultation and Research in the Department of Medical Research for statistical assistance, and all colleagues in the Nuclear Medicine Department for image acquisition and processing. The authors also thank the National Taiwan University Hospital and National Taiwan University College of Medicine for their generous support.

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