FDG-PET has no definite role in preoperative imaging in gastric cancer

Dassen, Anneriet E.; Lips, Daan J.; Hoekstra, C.; Pruijt, J.F.M.; Bosscha, K.

doi:10.1016/j.ejso.2008.11.010

Cited by 124 publications

(122 citation statements)

References 36 publications

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“…These results confirm the analysis of another review that showed neither AUS, MDCT, conventional MRI, nor PET could reliably confirm or exclude the presence of LN metastasis [66]. Tumor-positive LNs are not always enlarged, and certain enlarged LNs are not always tumor-positive but instead are enlarged due to inflammation, both of these possibilities make N staging extremely difficult [15,66]. Moreover, there are varying LN size criteria (ranging from [6 mm to [1 cm) required for LN detection [10].…”

Section: Evaluation Of N Stagingsupporting

confidence: 75%

“…However, SUVs are dependent on several factors, including time post FDG injection, tumor size, normoglycemia, and technical parameters [16,17]. PET is also highly dependent upon the pathological subtype of the cancer, as mucinous tumors may give false-negative results [15].…”

mentioning

confidence: 99%

“…Furthermore, MRI is limited in the amount of body coverage that can be achieved in a single exam, making it unsuitable for M staging [14]. 18-F-Fluoro-2-deoxyglucose positron emission tomography (FDG-PET, simplified as PET throughout this paper) uses a semi-quantitative method, the standardized uptake value (SUV), to assess the uptake of FDG in a tumor [15]. However, SUVs are dependent on several factors, including time post FDG injection, tumor size, normoglycemia, and technical parameters [16,17].…”

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confidence: 99%

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How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

et al. 2011

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Background Surgery is the fundamental curative option for gastric cancer patients. Imaging scans are routinely prescribed in an attempt to stage the disease prior to surgery. Consequently, the correlation between radiology exams and pathology is crucial for appropriate treatment planning. Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 1, 2009. We calculated the accuracy, overstaging rate, understaging rate, Kappa statistic, sensitivity, and specificity for abdominal ultrasound (AUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) with respect to the gold standard (pathology). We also compared the performance of CT by detector number and image type. A meta-analysis was performed. Results For pre-operative T staging MRI scans had better performance accuracy than CT and AUS; CT scanners using C4 detectors and multi-planar reformatted (MPR) images had higher staging performances than scanners with \4 detectors and axial images only. For pre-operative N staging PET had the lowest sensitivity, but the highest specificity among modalities; CT performance did not significantly differ by detector number or addition of MPR images. For pre-operative M staging performance did not significantly differ by modality, detector number, or MPR images. Conclusions The agreement between pre-operative TNM staging by imaging scans and post-operative staging by pathology is not perfect and may affect treatment decisions. Operator dependence and heterogeneity of data may Electronic supplementary material The online version of this article

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Section: Evaluation Of N Stagingsupporting

confidence: 75%

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confidence: 99%

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confidence: 99%

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How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

et al. 2011

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“…Nakamoto et al [37] performed a retrospective review of 92 consecutive patients who underwent PET-either integrated PET/CT or manual fusion of dedicated PET and CT-scans for posttreatment surveillance of gastric cancer. Of these patients, 46 were suspected of having a recurrence based on the findings of other imaging modalities (Group A), recurrence was predicted in 19 patients by tumor markers without definite findings (Group B), and the remaining 27 patients underwent a PET scan without evidence of recurrence (Group C). Gastric cancer recurrence was confirmed in 31 patients (67%) in Group A, in 11 patients (58%) in Group B, and in 2 patients (7%) in Group C. On a per-patientbasis, the sensitivity, specificity, and diagnostic accuracy of PET for recurrence were 81, 87, and 83% in Group A; 73, 88, and 79% in Group B; and 50, 88, and 85% in Group C. Therapeutic management was influenced by the PET results in 22 patients (48%) in Group A, in 8 patients (42%) in Group B, and in 2 patients (7%) in Group C, including cases in which PET was helpful for detecting a second primary cancer.…”

Section: Utility Of Pet In Detecting Recurrent Gastric Cancermentioning

confidence: 99%

“…On the other hand, the evaluation of neoadjuvant therapy requires not only the response of the main tumor but also the response of metastatic lymph node. The relationship between the prognosis of patients who have received neoadjuvant treatment and FDG uptake in metastatic lymph node after treatment should be studied, and prognostic criteria of FDG uptake after neo-adjuvant therapy should be established [46].…”

Section: Usefulness Of Pet In Evaluation Of Treatment Responsementioning

confidence: 99%

Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature

et al. 2011

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Since April 2010, the Japanese Public Health Insurance System has covered the costs incurred for performing 18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) imaging for patients with advanced gastric cancer. The aim of this review was to evaluate the clinical impact of PET for patients with gastric cancer. A systematic literature search was performed in PubMed/MEDLINE using the keywords ''gastric cancer'' and ''PET'' to search for relevant articles published from January 2000 to September 2010. The clinical impact of selected articles was assessed by the authors to evaluate the following: (a) tumor staging, (b) diagnosis for recurrent disease, (c) evaluation of treatment response, and (d) screening for gastric cancer. FDG uptake increases in papillary adenocarcinoma, tubular adenocarcinoma, and solid-type poorly differentiated adenocarcinoma. This uptake is also associated with glucose transporter 1 expression. The sensitivity and specificity of FDG-PET for metastatic lymph node detection were 21-40% and 89-100%, respectively. The sensitivity and specificity for distant metastasis detection were 35-74% and 74-99%, respectively. Treatment response can be detectable at an earlier stage by PET than by computed tomography (CT), because FDG uptake by cancer cells decreases according to the treatment response. In summary, although PET has limitations such as frequent false-negative cases in signetring cell carcinoma and non-solid type poorly differentiated carcinoma, it can contribute to the selection of a more appropriate treatment modality by detecting distant metastases and treatment response.

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¹⁸F-Fludeoxyglucose–Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer

Gertsen¹,

Brenkman²,

Hillegersberg³

et al. 2021

JAMA Surg

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IMPORTANCEThe optimal staging for gastric cancer remains a matter of debate.OBJECTIVE To evaluate the value of 18 F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer. DESIGN, SETTING, AND PARTICIPANTSThis multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (ՆcT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020.EXPOSURES All patients underwent an FDG-PET/CT and/or SL in addition to initial staging. MAIN OUTCOMES AND MEASURESThe primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay. RESULTSOf the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days.CONCLUSIONS AND RELEVANCE This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT.

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FDG-PET has no definite role in preoperative imaging in gastric cancer

Cited by 124 publications

References 36 publications

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature

¹⁸F-Fludeoxyglucose–Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer

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FDG-PET has no definite role in preoperative imaging in gastric cancer

Cited by 124 publications

References 36 publications

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature

18F-Fludeoxyglucose–Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer

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¹⁸F-Fludeoxyglucose–Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer