The role of 18F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: can the results of FDG PET/CT influence patients’ treatment decision making?

Bılıcı, Ahmet; Ustaalıoğlu, Bala Başak Öven; Şeker, Mesut; Kefeli, Umut; Canpolat, Nur; Tekinsoy, Bülent; Özuğur, Şule; Gümüş, Mahmut

doi:10.1007/s00259-010-1611-1

Cited by 46 publications

(46 citation statements)

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“…Park et al [19] reported that the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for diagnosing true recurrence of gastric cancer were 75%, 77%, 89%, 55% and 75%, respectively. In a study of contrast-enhanced FDG PET/CT, Bilici et al [12] reported superior diagnostic performance of FDG PET/CT over CECT. Although FDG PET/CT has been used for detecting recurrent gastric cancer, several limitations have been suggested for evaluating the remnant stomach.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite advances in the management of recurrent gastric cancer, several studies have reported a poor prognosis for patients with recurrent gastric cancer [2,5,7,9,10]. Imaging modalities, including contrast-enhanced computed tomography (CECT) and endoscopy, have been used for the detection of gastric cancer recurrence [4,11,12]. However, a gold standard modality has not been established.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, F-18 FDG PET, which is a non-invasive imaging modality that reflects glucose metabolism in the region of interest, especially in malignant cells, has been widely used for staging and restaging of a malignancy, determination of treatment response and detection of tumor recurrence in various cancers [2,12,19,20]. It is generally accepted that integrated PET/CT provides superior performance in the evaluation of a malignancy compared to PET or CT alone [12,19].…”

Section: Introductionmentioning

confidence: 99%

“…It is generally accepted that integrated PET/CT provides superior performance in the evaluation of a malignancy compared to PET or CT alone [12,19]. Several FDG PET and PET/CT studies have reported variable FDG uptake of primary gastric malignancies according to their histological subtypes [6].…”

Section: Introductionmentioning

confidence: 99%

“…Several FDG PET and PET/CT studies have reported variable FDG uptake of primary gastric malignancies according to their histological subtypes [6]. However, only a few studies have been reported regarding the use of PET in recurrent gastric cancer [2,6,12,19]. In addition, no reports have focused on the anastomotic site, the most common site of local recurrence [5], with F-18 FDG PET/CT.…”

Section: Introductionmentioning

confidence: 99%

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Significance of SUV on Follow-up F-18 FDG PET at the Anastomotic Site of Gastroduodenostomy after Distal Subtotal Gastrectomy in Patients with Gastric Cancer

Choi

Zeon

Kim

et al. 2011

Nucl Med Mol Imaging

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Purpose The aim of this study was to characterize the patterns of fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography/computed tomography (FDG PET/CT) at the anastomotic site of gastroduodenostomy after distal subtotal gastrectomy in patients with gastric cancer. Methods From May 2007 to May 2010, two or more follow-up measurements using FDG PET/CT scans were done for 19 patients (11 men, 8 women; mean age, 62.0± 10.3 years) who underwent distal subtotal gastrectomy with gastroduodenostomy between February 2006 and March 2008 for detecting gastric cancer recurrence at our medical center. The FDG PET/CT images were retrospectively reviewed. Patients with local recurrence, regional nodal metastasis or distant metastasis on follow-up studies were excluded. CT and endoscopy were done within 1 month before or after the FDG PET/CT scan. Eight patients had two follow-ups of FDG PET/CT, and 11 patients had three follow-ups. The mean interval between surgery and the first follow-up FDG PET/CT was 12.9±0.8 months (n=19); between the first and second it was 12.3±1.0 months (n= 19); between the second and third it was 11.6±0.7 months (n=11). The F-18 FDG uptakes at the anastomotic site and fundus in the remnant stomach were measured by maximum standardized uptake value (SUVmax) using a region of interest technique.Results The SUVmax at the anastomotic site was significantly higher than that of the fundus on all series of first, second and third follow-up studies (3.3±1.1 vs. 2.1±0.7, p<0.001: 3.1±0.9 vs. 2.2±0.7, p=0.001: 3.0±0.6 vs. 2.1±0.7, p=0.006, respectively). The SUVmax for the anastomotic site and fundus, and SUVmax ratio for the anastomotic site over the fundus were not significantly different throughout the series. Conclusion The SUVmax at the anastomotic site is significantly higher than that of the fundus and does not decrease significantly over time. Therefore, the local recurrence of gastric cancer after surgery could not be definitely differentiated from physiologic uptake or postoperative inflammatory change.

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Section: Discussionmentioning

confidence: 99%