Value of Preoperative PET-CT in the Prediction of Pathological Stage of Gastric Cancer

Kudou, Michihiro; Kosuga, Toshiyuki; Kubota, Takeshi; Okamoto, Kazuma; Komatsu, Shuhei; Shoda, Katsutoshi; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Arita, Tomohiro; Morimura, Ryo; Murayama, Yasutoshi; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Otsuji, Eigo

doi:10.1245/s10434-018-6455-0

Cited by 26 publications

(23 citation statements)

References 25 publications

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“…subcentimetre. Our reported specificity in lymph nodal status is much higher than the sensitivity, 73%, although this figure is lower than that reported by others [33,29]; this was possibly due to patients in our surgical cohort who underwent neoadjuvant chemotherapy and downstaging. Interestingly, recent studies specifically examining the significance of nodal FDG avidity have found poorer prognosis among patients with nodal FDG positivity, suggesting that PET-CT may identify a subset of cancers with a greater propensity to metastasise [11,29].…”

Section: Discussioncontrasting

confidence: 81%

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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: Discussioncontrasting

confidence: 81%

“…For the assessment of locoregional lymph nodal staging in gastric cancer, FDG PET-CT is more specific but less sensitive than CT alone [25][26][27]. However, recent studies have shown poorer prognosis for patients with FDG-avid nodes [11,28,29], suggesting an additional role for PET-CT in identifying patients at higher risk of metastasis.…”

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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“…Since the sensitivity and specificity of CT scan to identify metastatic lymph nodes remains unsatisfactory in gastric cancer patients, 18 FDG PET-CT scan is frequently used as a complementary tool to verify distant metastasis in gastric cancer patients with equivocal CT findings. PET-CT has demonstrated high specificity rate, ranging from 90.5 to 100% in detecting metastatic nodes of gastric cancer patients in recent studies, albeit with a markedly lower sensitivity of 22.7–58.3% [ [5] , [6] , [7] , [8] ]. Although infrequently encountered, false-positivity of PET-CT scans has been reported, including cases of metabolically active but benign diseases such as infection (including tuberculosis and aspergillosis), sarcoidosis, and other granulomatous diseases [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) historically has demonstrated lower sensitivity (22.7–58.3 %) but significantly higher specificity (90.5–100%) in detecting lymph node metastasis of gastric cancer compared to the commonly used CT scans, particularly in intestinal-type tumors [ [5] , [6] , [7] , [8] ]. FDG-PET integrated with CT can demonstrate anatomic and functional characteristics of the lesions at the same time in one image providing improved diagnostic capacity.…”

Section: Introductionmentioning

confidence: 99%

Anthracosilicosis mimicking extensive nodal metastasis from early gastric cancer: A case report

Park

2018

International Journal of Surgery Case Reports

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“…In recent years, preoperative detection of LNM has depended on imaging studies, such as contrast-enhanced computed tomography (CECT), upper endoscopy, and magnetic resonance imaging (MRI). Nevertheless, it is very challenging for these conventional modalities to accurately detect LNM because of their low sensitivities and specificities [10,11]. Therefore, additional methods are necessary to detect LNM before operation when imaging studies are unavailable or the results are not accurate.…”

Section: Introductionmentioning

confidence: 99%

The significance of preoperative serum carcinoembryonic antigen levels in the prediction of lymph node metastasis and prognosis in locally advanced gastric cancer: a retrospective analysis

et al. 2020

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Background: In this study, we aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC). Methods: The significance of the preoperative serum CEA level for the diagnose of LAGC and prediction of LNM was determined using the receiver operating characteristic (ROC) curve. The areas under the ROC of CEA were compared with those of other tumor markers or imaging examination including CT and MRI. Logistic regression was utilized to identify the risk factors predicting positive LNM. Independent prognosis factors were evaluated using univariate and multivariate COX regression analyses. Results:The ROC curves showed that the AUCs of CEA, CA199, and CA125 for diagnosing LAGC were 0.727, 0.594, and 0.566. When used to predict LNM, the AUC of CEA, CA199 and CA125 were 0.696, 0.531, and 0.588. Logistic regression analysis demonstrated that preoperative serum CEA were significantly associated with positive LNM. On combining imaging examination with CEA, the sensitivity and specificity were 85.3 and 79.4%, respectively, with the AUC equal to 0.853. The combination of CEA and imaging examination preformed the highest levels of AUC and sensitivity for diagnosing LNM, which is significantly higher than using either of them alone. Although patients with abnormal CEA have a poor prognosis, two models of multivariate analysis showed that CEA was not the independent prognosis factor for survival.Conclusions: CEA can be used to diagnose gastric cancer and determine whether it has LNM. Moreover, combined with CEA could improve the diagnostic sensitivity of imaging examination for lymph node involvement.

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Value of Preoperative PET-CT in the Prediction of Pathological Stage of Gastric Cancer

Abstract: PET-CT appears to be a useful complementary modality in the assessment of pStage III/IV because of the high sensitivity of FDG uptake in the primary tumor and the high specificity of FDG uptake in the lymph nodes.

Cited by 26 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

Anthracosilicosis mimicking extensive nodal metastasis from early gastric cancer: A case report

The significance of preoperative serum carcinoembryonic antigen levels in the prediction of lymph node metastasis and prognosis in locally advanced gastric cancer: a retrospective analysis

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