Usefulness of Preoperative 18F-FDG-PET in Detecting Invasive Intraductal Papillary Neoplasm of the Bile Duct

Background/Aim: Preoperative identification of the invasive component remains challenging in intraductal papillary neoplasm of the bile duct (IPNB). We evaluated the ability of preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) to differentiate between non-invasive IPNB, invasive IPNB, and papillary cholangiocarcinoma (CCA). Patients and Methods: The maximum standardized uptake values (SUV_max) of 11 patients with IPNB (6 non-invasive and 5 invasive) and 20 with papillary CCA who underwent pre-surgical ¹⁸F-FDG-PET were assessed. The SUV_max cut-off that predicts an invasive component was determined using receiver operating characteristic (ROC) curve analysis. Results: The SUV_max in patients with invasive IPNB and papillary CCA were significantly higher than in patients with non-invasive IPNB (p=0.035 and 0.0025, respectively). ROC curve analysis revealed an optimal SUV_max cut-off of 4.5, which had 94.5% accuracy, 76.0% sensitivity, and 100% specificity. Conclusion: Our data suggest that the preoperative ¹⁸F-FDG-PET SUV_max can differentiate non-invasive IPNB from invasive IPNB and papillary CCA.

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