Role of SUVmax obtained by 18F-FDG PET/CT in patients with a solitary pancreatic lesion: Predicting malignant potential and proliferation

Maximum standardized uptake value (SUVmax) is a marker of tumor glucose metabolism detected by [18F]-fluorodeoxyglucose (18F-FDG) PET/computed tomography (PET/CT) and reflects tumor aggressiveness. The aim of the study was to evaluate the value of SUVmax in differentiating benign from malignant solitary pancreatic lesions and explore the correlation between SUVmax and tumor proliferative activity. 18F-FDG PET/CT scans were performed in 80 patients with solitary pancreatic lesions who were scheduled for resective surgery. The relationships between SUVmax and postoperative pathologic diagnosis, histologic grade, and Ki-67 proliferation index (PI) were analyzed. Of these 80 patients, 54 had malignant lesions. The SUVmax of malignant tumors (6.3±2.4) was significantly greater than that of benign lesions (2.9±2.0) (P<0.001). Receiver-operating characteristic curve analysis showed that the SUVmax cutoff value of 3.5 had a high sensitivity (92.6%) and specificity (76.9%) for the diagnosis of malignancies. Among pancreatic cancers with low (Ki-67<5%), moderate (5%≤Ki-67<50%), and high (Ki-67≥50%) PI, SUVmax increased significantly from 4.2±1.2, through 6.0±1.7, to 8.6±2.5 (P<0.001). The SUVmax had a positive correlation with Ki-67 PI (P<0.001, r=0.60). The SUVmax of 18F-FDG PET/CT can be used in the differential diagnosis of solitary pancreatic lesions and can also aid in the prediction of proliferative activity of pancreatic cancer.