J Gastric Cancer.  2012 Sep;12(3):179-186.

18F-2-Deoxy-2-Fluoro-D-Glucose Positron Emission Tomography: Computed Tomography for Preoperative Staging in Gastric Cancer Patients

• Youn SH
• Seo KW
• Lee SH
• Shin YM
• Yoon KY

Abstract

PURPOSE
The use of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography-computed tomography as a routine preoperative modality is increasing for gastric cancer despite controversy with its usefulness in preoperative staging. In this study we aimed to determine the usefulness of preoperative positron emission tomography-computed tomography scans for staging of gastric cancer.
MATERIALS AND METHODS
We retrospectively analyzed 396 patients' positron emission tomography-computed tomography scans acquired for preoperative staging from January to December 2009.
RESULTS
The sensitivity of positron emission tomography-computed tomography for detecting early gastric cancer was 20.7% and it was 74.2% for advanced gastric cancer. The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity. For regional lymph node metastasis, the sensitivity and specificity of the positron emission tomography-computed tomography were 30.7% and 94.7%, respectively. There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value. Fluorodeoxyglucose uptake was detected by positron emission tomography-computed tomography in 24 lesions other than the primary tumors. Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers. Only two cases were detected purely by positron emission tomography-computed tomography.
CONCLUSIONS
Positron emission tomography-computed tomography could be useful in detecting metastasis or another primary cancer for preoperative staging in gastric cancer patients, but not for T or N staging. More prospective studies are needed to determine whether positron emission tomography-computed tomography scans should be considered a routine preoperative imaging modality.

Keyword

Positron-emission tomography and computed tomography; Cancer staging; Stomach neoplasms

MeSH Terms

Electrons
Humans
Lymph Nodes
Neoplasm Metastasis
Neoplasm Staging
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
Sensitivity and Specificity
Stomach Neoplasms
Biomarkers, Tumor

Figure

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  Fig. 1 Correlation between SUVmax and T stage (R2=0.05). SUVmax = maximum standardized uptake value.

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  Fig. 2 Correlation between tumor markers and SUVmax. (A) Correlation between CEA and SUVmax (R2=0.001). (B) Correlation between CA 19-9 and SUVmax (R2=0.005). CEA = carcinoembryonic antigen; SUVmax = maximum standardized uptake value; CA19-9 = carbohydrate antigen 19-9.

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  Fig. 3 Case series of positive FDG uptake in another lesion. (A) Colon. (B) Liver. (C) Lung. (D) Thyroid. (E) Gall bladder. (F) Bone. (G) Other. Four cases in the lung(s), one case in the thyroid, two cases in the gall bladder, two cases in the bone, one case in the breast and one case of cerebellar uptake were observed and progress was evaluated with PET-CT alone. One case of lung uptake and one case of bone uptake were determined to be malignant. op = operation; abd. = abdominal; CT = computed tomography; HCC = hepatocellular carcinoma; Tb = tuberculosis; EBU5 = endobronchial ultrasonography; FNA = fine needle aspiration; F/U = follow-up; GB = gall bladder; R/O = rule out; LADG = laparoscopic assisted distal gastrectomy; PET = positron emission tomography; TCD = transcranial doppler; FDG = fluorodeoxyglucose.

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