FDG PET/CT in pancreatic cancer staging and management: A retrospective study.
Bibliographic record
Abstract
464 Background: FDG PET/CT scan (PET) has been approved by Cancer Care Ontario since 2011 for pancreatic cancer patients who have potentially resectable disease. A recent prospective study supported the use of PET in patients with a pancreatic mass and showed improved staging accuracy. Herein, we reviewed the outcomes of PET in the disease staging and management of patients with pancreatic mass at a single academic center. Methods: We collected demographics, CA 19-9 level, CT, MRI and PET results of patients with suspicious pancreas mass followed at Sunnybrook Health Sciences Centre from April to August 2011. We reviewed disease staging after CT/MRI and clinical management decision after PET result. We excluded patients with proven non-primary adenocarcinoma of the pancreas from the analysis. Results: In this cohort, 58 patients had PET scans. 14 patients with non-primary adenocarcinoma of the pancreas were excluded. From 44 patients analyzed, 61% of them were females, median age 70, 19 patients had biliary obstruction with biliary drain, CA 19.9 was elevated preoperatively in 27 patients (level above 1400 was seen in 37% of 44 patients), pancreatic mass median SUV = 4.8 and 7 patients had SUV < 2.5 with no FDG avid at the pancreas mass (both biopsy proven). Ten patients were discovered to have metastatic disease on PET. PET results were discordant with the CT/MRI disease staging in 34% of cases. PET revealed metastatic disease in 7 patients with prior CT or MRI considered to be negative for metastasis. PET showed localized disease in 8 patients with suspicious metastasis on CT or MRI. However, none of the patients underwent pancreatic resection. Clinical management was changed after PET results in 80% of patients with discordant PET and CT/MRI results. Conclusions: In this single-centre retrospective analysis, PET results changed the metastatic disease status depicted by CT or MRI in 34% of patients and clinical management was guided by PET results for the majority of those patients. This supports the use of PET as a tool to guide staging and treatment of pancreas cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".