F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer

Abstract

PurposeTo investigate the clinical benefits of F18-fluorodeoxyglucose-positron emission tomography and computed tomography (18F-FDG-PET/CT) over multi-detector row CT (MDCT) in preoperative staging of gastric cancer.MethodsFDG-PET/CT and MDCT were performed on 78 patients with gastric cancer pathologically diagnosed by endoscopy. The accuracy of radiologic staging retrospectively was compared to pathologic result after curative resection.ResultsPrimary tumors were detected in 51 (65.4%) patients with 18F-FDG-PET/CT, and 47 (60.3%) patients with MDCT. Regarding detection of lymph node metastasis, the sensitivity of FDG-PET/CT was 51.5% with an accuracy of 71.8%, whereas those of MDCT were 69.7% and 69.2%, respectively. The sensitivity of 18F-FDG-PET/CT for a primary tumor with signet ring cell carcinoma was lower than that of 18F-FDG-PET/CT for a primary tumor with non-signet ring cell carcinoma (35.3% vs. 73.8%, P < 0.01).ConclusionDue to its low sensitivity, 18F-FDG-PET/CT alone shows no definite clinical benefit for prediction of lymph node metastasis in preoperative staging of gastric cancer.

Improving Patient Selection for 18F-FDG PET Scanning in the Staging of Gastric Cancer

“…However, the routine use of 18 F-FDG PET in preoperative staging has been suggested to be of limited value because of its low sensitivity for the detection of the primary gastric cancer and lymph node metastases (9,22).…”

“…18 F-FDG PET, now routinely combined with CT as a hybrid imaging modality, is a noninvasive functional imaging modality that has proven to be a useful staging tool in many cancers, including esophageal and lung cancer (2,3). However, its clinical value in gastric cancer remains controversial, as reports indicate that gastric cancer is not 18 F-FDG-avid in up to 53% of cases (4)(5)(6)(7)(8)(9)(10). This lack of avidity can result in a relatively low sensitivity for the detection of the primary tumor, nodal disease, and, consequently, distant metastatic disease.…”

Concordance of positron emission tomography and computed tomography in patients with locally advanced gastric and esophageal cancer

“…Park et al found both of these imaging methods to be inadequate for detecting regional lymph nodes, when compared with postoperative pathologic results [16]. In another study, there was similar imaging accuracy on PET- CT and CT for detecting lymph node metastases (71.8 and 69.2 %, respectively) [15]. Coupe and colleagues who retrospectively evaluated 97 patients undergoing PET-CT with involvement of lymph nodes showed shorter survival compared to patients with no lymph node involvement (p \ 0.0001) [19].…”

“…In this study, the primary tumor was detected in 119 (80 %) of patients with PET-CT and the accuracy of CT compared to PET-CT for detecting lymph node staging was 72 % with 55 % sensitivity and 90 % specificity [14]. In a Korean retrospective study, 78 patients with gastric cancer were evaluated preoperatively with PET-CT and CT for staging of primary tumor, and finally both imaging techniques were found to be similar for staging primary tumor (PET-CT 65 %, CT 60 %) [15]. Another retrospective study was conducted by Park and his colleagues, who evaluated 74 patients with gastric cancer who had PET-CT and CT preoperatively for staging purposes.…”

Identification of a DNA methylation marker that detects the presence of lymph node metastases of gastric cancers

“…Imaging modalities, including computed tomography (CT), endoscopic ultrasonography (EUS) and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) are used in clinical practice. However, the sensitivities of these modalities are 77.2, 82.8 and 71%, respectively, and the specificities are 78.3, 74.2 and 74%, respectively (10)(11)(12)(13). Moreover, these imaging modalities are almost powerless to detect micrometastases (14,15).…”