Detecting the Recurrence of Gastric Cancer after Curative Resection: Comparison of FDG PET/CT and Contrast-Enhanced Abdominal CT

Abstract

The purpose of this study was to evaluate the value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for detecting the recurrence of gastric cancer. We performed a retrospective review of 139 consecutive patients who underwent PET/CT and contrast-enhanced abdominal CT (CECT) for surveillance of gastric cancer after curative resection. Recurrence of gastric cancer was validated by histopathologic examination for local recurrence or serial imaging study follow-up with at least 1 yr interval for recurrence of distant metastasis form. Twenty-eight patients (20.1%) were confirmed as recurrence. On the patient based analysis, there was no statistically significant difference in the sensitivity, specificity and accuracy of PET/CT (53.6%, 84.7%, and 78.4%, respectively) and those of CECT (64.3%, 86.5%, and 82.0%, respectively) for detecting tumor recurrence except in detection of peritoneal carcinomatosis. Among 36 recurrent lesions, 8 lesions (22.2%) were detected only on PET/CT, and 10 lesions (27.8%) only on CECT. PET/CT had detected secondary malignancy in 8 patients. PET/CT is as accurate as CECT in detection of gastric cancer recurrence after curative resection, excepting detection of peritoneal carcinomatosis. Moreover, additional PET/CT on CECT could improve detection rate of tumor recurrence and provide other critical information such as unexpected secondary malignancy.

Diagnostic and prognostic value of circulating miR-18a in the plasma of patients with gastric cancer

“…Curative surgery is still the most effective treatment for gastric cancer, whereas the 5-year survival rate for gastric cancer is still less than 20-25 % in China, Europe, and USA [3]. Even worse, about 80 % of the patients with advanced gastric cancer die within a short period after surgery for distant metastasis (30 %) and locoregional recurrence (87 %) [4]. On the contrary, complete surgical resection may offer a cure for 90 % of the patients with early gastric cancer [5].…”

Primary Tumor 18F-FDG Avidity Affects the Performance of 18F-FDG PET/CT for Detecting Gastric Cancer Recurrence

“…In particular, peritoneal involvement is notoriously difficult to detect by 18 F-FDG PET (8,26). We also found a low overall PET sensitivity of 57.9% for detecting peritoneal recurrence.…”

“…The current guidelines of the National Comprehensive Cancer Network state that 18 F-FDG PET/CT is useful for the evaluation of recurrent gastric cancer (5). However, studies to date have shown inconsistent results regarding the performance of 18 F-FDG PET/CT for this purpose (6)(7)(8), and there are concerns that low diagnostic sensitivity may limit its usefulness (9). As such, it would be clinically useful to identify subpopulations of gastric cancer patients who are most likely to benefit from surveillance with 18 F-FDG PET/CT after curative gastrectomy (10,11).…”

Potential Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gastrointestinal and Abdominal Malignancies: Preliminary Experience

“…Compared with abdominal CE-CT, [ 18 F]-FDG-PET showed lower sensitivity, specificity, and accuracy (52.0%, 83.7%, 76.9% of PET vs 68.0%, 87.0%, 82.9% of CT, respectively), although with no significant difference (P 4 0.05). 82 With regard to predicting prognosis, [ 18 F]-FDG-PET may provide additional information. In patients with proven recurrence, the mean survival for the PET-negative group was higher compared with the PET-positive group (18.5 Ϯ 12.5 vs 6.9 Ϯ 6.5 months).…”