gms | German Medical Science

121. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

27. bis 30.04.2004, Berlin

Integrated Positron-Emission Tomography and Computed Tomography (PET/CT) is Highly Sensitive for Gallbladder Cancer but not for Carcinomas of the Extrahepatic Bile Duct System


  • presenting/speaker Peer Wildbrett - Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
  • M. Schäfer - Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
  • Z. Kadry - Chirurgo Responsabile chirurgia trapianto addominale, ISMETT - UPMC Italy, Palermo, Italy.
  • H. Petrowsky - Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
  • T. Hany - Department of Medical Radiology, Division of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.
  • W. Jochum - Department of Pathology, Zurich University Hospital, Zurich, Switzerland.
  • P.A. Clavien - Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.

Deutsche Gesellschaft für Chirurgie. 121. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 27.-30.04.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dgch1350

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Veröffentlicht: 7. Oktober 2004

© 2004 Wildbrett et al.
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The overall prognosis of malignant tumors of the intrahepatic biliary tree, extrahepatic bile duct and gallbladder remains poor. To assess staging and resectability, ultrasound and computed tomography (CT) are the standard imaging tests for gallbladder cancer whereas CT and cholangiography are standard test for intrahepatic cholangiocarcinoma and extrahepatic bile duct cancer. PET/CT is a new imaging modality that provides both anatomic and metabolic information of tumors. The goal of this study was to evaluate if PET/CT is a useful diagnostic tool to detect the primary tumor of malignancies of the biliary tree.

Materials and methods

From May 2000 to May 2003, 25 patients (male n=9, female n=16, median age 58,5 years) with malignancies of the biliary tree were included in the study. The study population was composed of 10 patients with Klatskin tumor, 7 with gallbladder cancer, 4 with intrahepatic cholangiocarcinoma and 4 with extrahepatic bile duct cancer. The majority of patients (n=17) underwent surgical resectional procedures whereas 8 patients had either no surgery or laparoscopy only. All tumors were proven by histology either of the resection specimen, tumor biopsy, or brush cytology. All patients had a PET/CT for diagnostic work-up. The 17 patients who underwent resectional procedures had their PET/CT prior surgery. All imaging and data acquisition were performed with a combined PET/CT inline system that was able to acquire CT images and PET data for the same patient in one session. The PET/CT scans were independently evaluated using the standardized uptake value and a tumor/non-tumor ratio.


The results were highly dependent on the tumor type of the biliary tree. All 7 patients with gallbladder cancer had a high specific FDG uptake into the tumor demonstrating a sensitivity of PET/CT of 100%. High specific FDG uptake of the tumor was observed in 3/4 intrahepatic cholangiocarcinomas (75%), 1/4 extrahepatic bile duct cancers (25%), and 4/10 Klatskin tumors (40%). Sensitivity of PET/CT was significantly different between gallbladder cancer (100%) and Klatskin tumor (40%) using the Fishers exact test (p<0.05). Eight of 15 patients with high specific FDG uptake, 2 of 4 patients with unspecific FDG uptake and 4/6 patients with no FDG uptake had an ERCP or PTCD in their diagnostic work-up within 30 days before PET/CT. Prior cholangiography either by ERCP or PTCD had no influence on the PET/CT detection rate of extrahepatic bile duct and gallbladder cancer.


The preliminary data demonstrate that PET/CT is an useful diagnostic tool for gallbladder cancer and possibly also for intrahepatic cholangiocarcinoma to identify the primary tumor. This may help to assess staging and resectability of these tumors. In contrast, PET/CT of Klatskin and extrahepatic bile duct cancer had a low sensitivity and should therefore not considered for the work-up of these tumor types at this point. Future studies should be directed to the impact of PET/CT on staging, respectability, and survival of patients with gallbladder cancer and intrahepatic cholanangiocarcinoma.