The value of FDG‐PET in the staging of gastric adenocarcinoma: A single institution retrospective review

Serrano, Oscar K.; Love, Charito; Goldman, Inessa; Huang, Kevin Chih-Yang; Ng, Nicole; Abraham, Tony; Silva, Raphaella Da; Friedmann, Patricia; Libutti, Steven K.; Kennedy, Timothy J.

doi:10.1002/jso.24190

Cited by 16 publications

(11 citation statements)

References 25 publications

(46 reference statements)

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“…This guides treatment strategies away from the morbidity and mortality associated with a futile surgery, with no benefit for long-term survival, and avoidance of the considerable associated cost. This is consistent with previous studies, which have reported added information regarding occult metastases in up to 10% of patients [11,15,22,23]. A possible reason for the higher detection rate of metastases in our study compared to previous reports include improved scanning technology (e.g.…”

Section: Discussionsupporting

confidence: 92%

“…As FDG PET-CT has become more routinely available, more studies have examined its role in the staging of gastric adenocarcinoma. Recent reports have estimated the added diagnostic value of FDG PET-CT for detecting occult metastases as 6-10% [11,15,22,23] with accompanying reductions in surgical morbidity, mortality and cost by the avoidance of unnecessary gastrectomy. Due to relatively low spatial resolution, FDG PET-CT does not add to assessment of primary tumour (T) stage [24].…”

Section: Introductionmentioning

confidence: 99%

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Staging FDG PET-CT changes management in patients with gastric adenocarcinoma who are eligible for radical treatment

Bosch

Chicklore

Cook

et al. 2019

Eur J Nucl Med Mol Imaging

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Aim 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is valuable in the management of patients with oesophageal cancer, but a role in gastric cancer staging is debated. Our aim was to review the role of FDG PET-CT in a large gastric cancer cohort in a tertiary UK centre. Methods We retrospectively reviewed data from 330 patients presenting with gastric adenocarcinoma between March 2014 and December 2016 of whom 105 underwent pre-treatment staging FDG PET-CT scans. FDG PET-CT scans were graded qualitatively and quantitatively (SUV max) and compared with staging diagnostic CT and operative pathology results (n = 30) in those undergoing resection. Results Of the 105 patients (74 M, median age 73 years) 86% of primary tumours were metabolically active (uptake greater than normal stomach) on FDG PET-CT [41/44 (93%) of the intestinal histological subtype (SUV max 14.1 ± 1.3) compared to 36/46 (78%) of non-intestinal types (SUV max 9.0 ± 0.9), p = 0.005]. FDG PET-CT upstaged nodal or metastastic staging of 20 patients (19%; 13 intestinal, 6 non-intestinal, 1 not reported), with 17 showing distant metastases not evident on other imaging. On histological analysis, available in 30 patients, FDG PET-CT showed low sensitivity (40%) but higher specificity (73%) for nodal involvement. Conclusion FDG PET-CT provides new information in a clinically useful proportion of patients, which leads to changes in treatment strategy, most frequently by detecting previously unidentified metastases, particularly in those with intestinal-type tumours.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Staging FDG PET-CT changes management in patients with gastric adenocarcinoma who are eligible for radical treatment

Bosch

Chicklore

Cook

et al. 2019

Eur J Nucl Med Mol Imaging

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“…PET-CT was also used in the preoperative judgement of lymph node metastasis and demonstrated its advantage on distant lymph node metastasis and bone metastasis [21]. However, the accuracy of PET-CT for regional lymph node metastasis did not demonstrate an advantage over CT or EUS [22]. In addition, it is not commonly accepted because of its radiation and expensive cost.…”

Section: Discussionmentioning

confidence: 99%

“…In Luo's study, for example, the results showed that the evaluation accuracy of pathological stages T1 and T2 for gastric cancer by spiral CT was approximately 42.86%. In general, the accuracy rates in recent studies using multi-detector row CT for T and N staging have been reported to be 71.4–88.9% and 64–78%, respectively [22–25].…”

Section: Discussionmentioning

confidence: 99%

Nomogram analysis and external validation to predict the risk of lymph node metastasis in gastric cancer

Chen¹,

Nie

Ouyang

et al. 2017

Oncotarget

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AimTo identify risk factors for lymph node metastasis using a nomogram for gastric cancer patients to predict lymph node metastasis.ResultsThe Chi-square test and the logistic regression showed that the Boarrmann type, preoperative CA199 level, T stage and N stage by CT scan were independent risk factors. The concordance index (C-index) was 0.786 in the internal validation of the Nomogram model. In the external validation, the C-index was 0.809, and the AUC was 0.894. The total accuracy of the prediction was 82.2%, and the false-negative rate was 5.4% with a cut-off value set at 0.109.Materials and MethodsThe study consisted of 451 patients with a histological diagnosis of gastric cancer with 0 or 1 lymph node metastasis from the Sun Yat-sen University Cancer Center as the development set, and the validation set consisted of 186 gastric cancer patients from the Sixth Affiliated Hospital of Sun Yat-Sen University. A Chi-square test and a logistic regression analysis were used to compare the clinicopathological variables and lymph node metastasis. The C-index and ROC curve were computed for comparisons of the nomogram's predictive ability.ConclusionsWe developed and validated a nomogram to predict lymph node metastasis in gastric cancer before surgery. This nomogram can be broadly applied, even in general hospitals, and is useful for decisions regarding treatment programs for patients.

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“…Therefore, CT has some limitations for predicting LN metastases before surgery (8). On the other hand, 18-fluorodeoxyglucose (FDG) positron emission tomography integrated with CT (PET-CT) is used to investigate LN metastases of non-GCs because of its high specificity (9,10). The predictive value of PET/CT for LN evaluation is dependent on the ability of primary tumors to uptake 18-FDG, the number of LN metastases, the size of the LNs, and the presence of inflammation in areas of the body.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Evaluation of Lymph Node Metastases in Patients with Gastric Cancer: An Analysis of Imaging Methods

Günay¹,

Çağlar²,

Korkmaz³

et al. 2018

Acta Oncol Tur.

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Mide kanseri olan hastalarda ameliyat öncesi evrelendirme cerrahi tedavi için gereklidir. Ancak ameliyat öncesi lenf nodu (LN) değerlendirilmesinde tek başına yeterli olabilecek bir test bulunmamaktadır. Bu çalışmanın amacı mide kanseri olan hastalarda, ameliyat öncesi LN tutulumunun değerlendirilmesinde pozitron emisyon tomografisi (PET/BT) ile bilgisayarlı tomografinin (BT) tanısal değerlerinin karşılaştırılmasıdır. YÖNTEM ve GEREÇLER: Geriye dönük olarak gastrektomi ve D2 LN diseksiyonu ameliyatı olan seksen yedi hastanın değerlendirlmesidir. Görüntüleme yöntemleri ve patoloji raporları hasta dosyalarında toplandı. BULGULAR: PET/BT ile BT arasında mide kanseri olan hastalarda LN tutulumun kestirim gücü arasında anlamlı bir fark bulunmadı (p>0.05). PET/BT'nin LN nodunu öngerme duyarlılığı, özgüllüğü, pozitif kestirim değeri (PKD) ve negatif kestirim değeri (NKD) ile doğruluk değeri %55.56, %54.55, %55.26, %75 ve %33.3 olarak hesaplanırken BT için % 57.69, %59.42, %70.27, and %46.88 olarak bulundu. Ancak, hem PET/BT ve BT birlikte kullanıldığında ameliyat öncesi mide kanseri olan hastalardaki LN metastazı belirlemede özgüllük PKD % 80 ve % 88.9 olarak bulundu. Sonuçlarımıza göre hastaya veya tümöre ait herhangi bir özelliğin PET/BT veya BT'nin LN metastazı öngörme gücü üzerinde etkisi görülmedi. TARTIŞMA ve SONUÇ: PET/BT ve BT'nin birlikte kullanılması özgüllüğü ve PKD'ni arttırmaktadır. Bu artış, mide kanseri olan hastalarında ameliyat öncesi LN metastazı belirmede doğruluk değerini her iki testin ayrı ayrı kullanılmasında daha yüksektir. Anahtar Kelmeler: Mide kanseri, lenf nodu, bilgisayarlı tomografi, pozitron emisyon tomografi ABSTRACT INTRODUCTION: Preoperative evaluation is necessary for the surgical treatment of gastric cancer (GC). Nonetheless, there is no single best diagnostic modality to predict lymph node metastases prior to surgery. The aim of this study was to analyze of the diagnostic utility of positron emission tomography-computed tomography (PET-CT) and CT for the preoperative evaluation of lymph node (LN) metastases in GC. METHODS: Eighty seven patients with a history of GC, who underwent gastrectomy and D2 LN dissection were investigated. Imaging test results and pathology reports were collected from the patients' charts. RESULTS: There was no statistical differences between PET/CT and CT scans in regard to predicting LN metastases in GC patients (p>0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT scans in predicting LN metastases were 55.56%, 54.55%, 55.26%, 75%, and 33.3%, respectively, versus 60.47%, 57.69%, 59.42%, 70.27%, and 46.88% for CT scans, respectively. However, combined PET/CT and CT showed better outcomes and specificity with a PPV of 80% and 88.9%, respectively. No patients or tumor factors were found to increase the accuracy of LN metastasis prediction using either PET/CT or CT scans. DISCUSSION AND CONCLUSION: The combination of CT and PET/CT scans increases the specificity and PPV. This increases t...

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The value of FDG‐PET in the staging of gastric adenocarcinoma: A single institution retrospective review

Abstract: Our findings support the use of FDG-PET as a valuable adjunct to CT in the staging of GA, as it changed the stage in 48 (28.9%) patients. J. Surg. Oncol. 2016;113:640-646. © 2016 Wiley Periodicals, Inc.

Cited by 16 publications

References 25 publications

Staging FDG PET-CT changes management in patients with gastric adenocarcinoma who are eligible for radical treatment

Staging FDG PET-CT changes management in patients with gastric adenocarcinoma who are eligible for radical treatment

Nomogram analysis and external validation to predict the risk of lymph node metastasis in gastric cancer

Preoperative Evaluation of Lymph Node Metastases in Patients with Gastric Cancer: An Analysis of Imaging Methods

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