Yonsei Med J.  2011 Jan;52(1):81-88. 10.3349/ymj.2011.52.1.81.

The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence after Curative Gastrectomy

• Lee JE
• Hong SP
• Ahn DH
• Jeon TJ
• Kang MK
• Kwon CI
• Ko KH
• Hwang SG
• Park PW
• Rim KS

• KMID: 1106441
• DOI: http://doi.org/10.3349/ymj.2011.52.1.81

Abstract

PURPOSE
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans are frequently performed for the screening or staging of malignant tumors. This study aimed to assess the usefulness of 18F-FDG PET/CT in detection of gastric cancer recurrence after curative gastrectomy.
MATERIALS AND METHODS
Eighty nine patients who had undergone curative gastrectomy due to gastric cancer and had 18F-FDG PET/CT and contrast CT scans within 2 weeks for surveillance in asymptomatic patients (n = 11) or to clarify suspected recurrence (n = 78) were consecutively collected and retrospectively analyzed. They had clinical follow-up for at least 12 months after PET/CT and CT scans.
RESULTS
Fifteen of the 89 patients (16.9%) were diagnosed with recurrent gastric cancer in 21 organs. Forty one organs showed an increase in FDG uptake, and only 9 of these organs were diagnosed with recurrent gastric cancer by 18F-FDG PET/CT. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the 18F-FDG PET/CT were 42.9%, 59.7%, 29.3%, 78.2%, and 57.3%, respectively. On the CT scan, 18 of 21 recurrent gastric cancers were detected, and 7 cases were in agreement with the 18F-FDG PET/CT. The sensitivity and specificity of the CT scan were 85.8% and 87.3%, respectively, which are superior to the 18F-FDG PET/CT. When we diagnosed a recurrence based on either 18F-FDG PET/CT or CT scans, the sensitivity increased to 95.2% and the specificity decreased to 45.6%, when compared with the contrast CT scan alone.
CONCLUSION
18F-FDG PET/CT is an insufficient diagnostic method in detection of recurrence after curative gastrectomy, and even less accurate than contrast CT scan alone.

Keyword

Gastric cancer; recurrence; 18F-FDG PET/CT scan; contrast CT scan

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Fluorodeoxyglucose F18/*diagnostic use
*Gastrectomy
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/*diagnosis
Positron-Emission Tomography/*methods
Stomach Neoplasms/*diagnosis/*surgery
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 A case of recurring gastric cancer detected by FDG-uptake on PET/CT. This 57 year-old man showed no suspicion of recurrence on the abdomino-pelvic CT scan. However, on the whole body PET/CT scan, there was a high FDG-uptake on the left supraclavicular lymph node. This lesion was confirmed as distant nodal metastasis by biopsy. FDG, fluorodeoxyglucose; PET, positron emission.

• 

  Fig. 2 A case of recurrent gastric cancer detected by CT scan but showing no FDG-uptake on PET/CT. (A) This 52 year-old woman showed peritoneal carcinomatosis and right ovarian enlargement with septated cystic mass on CT scan. (B) However, on the 18F-FDG PET/CT scan, there was no abnormal FDG-uptake. The recurrence was confirmed by peritoneal fluid cytology. FDG, fluorodeoxyglucose; PET, positron emission.

Reference

1. Schwarz RE, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy. Ann Surg Oncol. 2002. 9:394–400.

2. Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000. 87:236–242.

3. Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, et al. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2006. 26:143–156.

4. Habermann CR, Weiss F, Riecken R, Homarpisheh H, Bohnacker S, Staedtler C, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004. 230:465–471.

5. Kuntz C, Herfarth C. Imaging diagnosis for staging of gastric cancer. Semin Surg Oncol. 1999. 17:96–102.

6. Halvorsen RA Jr, Yee J, McCormick VD. Diagnosis and staging of gastric cancer. Semin Oncol. 1996. 23:325–335.

7. Park MJ, Lee WJ, Lim HK, Park KW, Choi JY, Kim BT. Detecting recurrence of gastric cancer: the value of FDG PET/CT. Abdom Imaging. 2009. 34:441–447.

8. Sun L, Su XH, Guan YS, Pan WM, Luo ZM, Wei JH, et al. Clinical role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in post-operative follow up of gastric cancer: initial results. World J Gastroenterol. 2008. 14:4627–4632.

9. Sim SH, Kim YJ, Oh DY, Lee SH, Kim DW, Kang WJ, et al. The role of PET/CT in detection of gastric cancer recurrence. BMC Cancer. 2009. 9:73.

10. De Potter T, Flamen P, Van Cutsem E, Penninckx F, Filez L, Bormans G, et al. Whole-body PET with FDG for the diagnosis of recurrent gastric cancer. Eur J Nucl Med Mol Imaging. 2002. 29:525–529.

11. Nakamoto Y, Togashi K, Kaneta T, Fukuda H, Nakajima K, Kitajima K, et al. Clinical value of whole-body FDG-PET for recurrent gastric cancer: a multicenter study. Jpn J Clin Oncol. 2009. 39:297–302.

12. Sobin LH, Wittekind CH. TNM classification of malignant tumors. International union against cancer (UICC). 2002. 6th ed. New York: Wilwy-Liss.

13. Yun M, Kim BI. Roles of F-18 FDG PET or PET/CT for the evaluation of gastrointestinal malignancies. Korean J Gastroenterol. 2006. 48:378–387.

14. Yun M, Choi HS, Yoo E, Bong JK, Ryu YH, Lee JD. The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18F-FDG PET. J Nucl Med. 2005. 46:953–957.

15. Nunez RF, Yeung HW, Macapinlac H. Increased F-18 FDG uptake in the stomach. Clin Nucl Med. 1999. 24:281–282.

16. Beatty JS, Williams HT, Aldridge BA, Hughes MP, Vasudeva VS, Gucwa AL, et al. Incidental PET/CT findings in the cancer patient: how should they be managed? Surgery. 2009. 146:274–281.

17. Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET/CT. J Nucl Med. 2005. 46:752–757.