The current role of PET-CT in the characterization of hepatobiliary malignancies

Background: Surgery has become heavily dependent on accurate imaging in the assessment and treatment of suspected or confirmed intra-abdominal malignancy. Positron emission tomographycomputed tomography (PET-CT) fuses uptake of a radiotracer combined with CT images to assess both functional tissue activity and anatomical detail. Since its introduction it has offered new ways of treating gastrointestinal cancers. Methods: The review analyses the present literature regarding the use of PET-CT in the assessment, diagnosis, staging and treatment of hepatobiliary malignancies. Results: PET-CT is widely used in pre-operative tumours staging for colorectal liver metastases. There is convincing data that it may also be applicable for neuroendocrine tumours, assessment of indeterminate pancreas lesions and clinical drug trials. PET-CT is of limited value in hepatocellular cancers, although new techniques in dual-tracer PET-CT may change this. Conclusion: Knowledge of the strengths and limitations of PET-CT is important for all surgeons managing cancer of the hepatobiliary system. More clinical data are required on PET-CT, particularly its effect on long-term survival in PET-CT-staged patients undergoing resection.Ginseppe Garcea, Seok Ling Ong and Guy J. Madder