FDG-PET was Useful for the Diagnosis of Bile Duct Cancer in an Early Stage: Report of a Surgical Resection Case

We report a case in which FDG-PET was useful in diagnosing of early-stage extrahepatic bile duct cancer. A 60-year-old woman reporting right upper quadrant pain was found in abdominal ultrasonography to have a tumor in the common bile duct. Tumor markers in serum were slightly elevated (AFP: 11.2ng/ml, CA19-9: 41U/ml). Abdominal CT and ERCP showed a tumor in the middle bile duct, but we could not determine ma-lignancy. FDG-PET revealed a high accumulation of FDG with a standardized uptake value (SUV) of 3.6 and a SUV ratio of 2.8, which led to the diagnosis of cancer of the middle bile duct, necessitating pylorus-preserving pancreatoduodenectomy with standard lymph node resection. A papillary tumor 2 cm in diameter was found in the middle bile duct of the resected specimen. Microscopically, the tumor was a papillary adeno-carcinoma limited to the fibrous muscular layer and showing no lymph node metastasis. It is often difficult to diagnose malignancy of bile duct cancer in earlier stages, and FDG-PET may provide useful information in making a definitive diagnosis.