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The role of PET/CT in detection of gastric cancer recurrence.

Sim SH, Kim YJ, Oh DY, Lee SH, Kim DW, Kang WJ, Im SA, Kim TY, Kim WH, Heo DS, Bang YJ - BMC Cancer (2009)

Bottom Line: Among 13 patients whose image findings between two methods were discordant and tissue confirmation was difficult, the treatment decision was made in 7 patients based on PET/CT, showing the final diagnostic accuracy of 42.8% (3/7).PET/CT was as sensitive and specific as contrast CT in detection of recurred gastric cancer except peritoneal seeding.However, additional PET/CT on contrast CT did not increase diagnostic accuracy in detection of recurred gastric cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. boron@hanmail.net

ABSTRACT

Background: In the course of surveillance of gastric cancer recurrence after curative resection, contrast CT scan is used in general. However, new findings from CT scan are not always confirmatory for the recurrence. In this case, we usually use short-term follow up strategy or therapeutic intervention with clinical decision. Recently, the use of fusion Positron Emission Tomography/Computed Tomography (PET/CT) is increasing. The purpose of this study is to evaluate the efficacy and usefulness of PET/CT for detecting recurrence of gastric cancer after curative resection.

Methods: Fifty two patients who received curative resection of gastric cancer and had undergone PET/CT and contrast CT for surveillance of recurrence until Dec 2006 in Seoul National University Hospital were analyzed retrospectively. Recurrence of gastric cancer was validated by histologic confirmation (n = 17) or serial contrast CT follow up with at least 5 month interval (n = 35). McNemar's test and Fisher's exact test were used to evaluate sensitivity and specificity of PET/CT and contrast CT.

Results: Of 52 patients, 38 patients were confirmed as recurrence. The sensitivity was 68.4% (26/38) for PET/CT and 89.4% (34/38) for contrast CT (p = 0.057). The specificity was 71.4% (10/14) and 64.2% (9/14), respectively (p = 1.0). In terms of the recurred sites, the sensitivity and specificity of PET/CT were similar to those of contrast CT in all sites except peritoneum. Contrast CT was more sensitive than PET/CT (p = 0.039) for detecting peritoneal seeding. Additional PET/CT on contrast CT showed no further increase of positive predictive value regardless of sites. Among 13 patients whose image findings between two methods were discordant and tissue confirmation was difficult, the treatment decision was made in 7 patients based on PET/CT, showing the final diagnostic accuracy of 42.8% (3/7).

Conclusion: PET/CT was as sensitive and specific as contrast CT in detection of recurred gastric cancer except peritoneal seeding. However, additional PET/CT on contrast CT did not increase diagnostic accuracy in detection of recurred gastric cancer. Further studies are warranted to validate the role of PET/CT in detection of gastric cancer recurrence.

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Treatment decision by findings from fusion PET/CT when tissue confirmation is impossible. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1). But its final accuracy was 42.8% (3/7).
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Figure 1: Treatment decision by findings from fusion PET/CT when tissue confirmation is impossible. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1). But its final accuracy was 42.8% (3/7).

Mentions: When the tissue confirmation is impossible, clinical decision and its final diagnosis by contrast CT image follow-up is presented in figure 1. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1 and Figure 2). But its final accuracy was 42.8% (3/7). Age and stage distribution in these patients are presented in Table 5. Older and higher stage patients had a tendency of increased recurrence of gastric cancer regardless of results of the fusion PET/CT findings.


The role of PET/CT in detection of gastric cancer recurrence.

Sim SH, Kim YJ, Oh DY, Lee SH, Kim DW, Kang WJ, Im SA, Kim TY, Kim WH, Heo DS, Bang YJ - BMC Cancer (2009)

Treatment decision by findings from fusion PET/CT when tissue confirmation is impossible. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1). But its final accuracy was 42.8% (3/7).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651906&req=5

Figure 1: Treatment decision by findings from fusion PET/CT when tissue confirmation is impossible. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1). But its final accuracy was 42.8% (3/7).
Mentions: When the tissue confirmation is impossible, clinical decision and its final diagnosis by contrast CT image follow-up is presented in figure 1. When the image findings between the two methods were discordant, treatment decision was made according to the PET/CT findings in 7 out of 13 cases (Figure 1 and Figure 2). But its final accuracy was 42.8% (3/7). Age and stage distribution in these patients are presented in Table 5. Older and higher stage patients had a tendency of increased recurrence of gastric cancer regardless of results of the fusion PET/CT findings.

Bottom Line: Among 13 patients whose image findings between two methods were discordant and tissue confirmation was difficult, the treatment decision was made in 7 patients based on PET/CT, showing the final diagnostic accuracy of 42.8% (3/7).PET/CT was as sensitive and specific as contrast CT in detection of recurred gastric cancer except peritoneal seeding.However, additional PET/CT on contrast CT did not increase diagnostic accuracy in detection of recurred gastric cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. boron@hanmail.net

ABSTRACT

Background: In the course of surveillance of gastric cancer recurrence after curative resection, contrast CT scan is used in general. However, new findings from CT scan are not always confirmatory for the recurrence. In this case, we usually use short-term follow up strategy or therapeutic intervention with clinical decision. Recently, the use of fusion Positron Emission Tomography/Computed Tomography (PET/CT) is increasing. The purpose of this study is to evaluate the efficacy and usefulness of PET/CT for detecting recurrence of gastric cancer after curative resection.

Methods: Fifty two patients who received curative resection of gastric cancer and had undergone PET/CT and contrast CT for surveillance of recurrence until Dec 2006 in Seoul National University Hospital were analyzed retrospectively. Recurrence of gastric cancer was validated by histologic confirmation (n = 17) or serial contrast CT follow up with at least 5 month interval (n = 35). McNemar's test and Fisher's exact test were used to evaluate sensitivity and specificity of PET/CT and contrast CT.

Results: Of 52 patients, 38 patients were confirmed as recurrence. The sensitivity was 68.4% (26/38) for PET/CT and 89.4% (34/38) for contrast CT (p = 0.057). The specificity was 71.4% (10/14) and 64.2% (9/14), respectively (p = 1.0). In terms of the recurred sites, the sensitivity and specificity of PET/CT were similar to those of contrast CT in all sites except peritoneum. Contrast CT was more sensitive than PET/CT (p = 0.039) for detecting peritoneal seeding. Additional PET/CT on contrast CT showed no further increase of positive predictive value regardless of sites. Among 13 patients whose image findings between two methods were discordant and tissue confirmation was difficult, the treatment decision was made in 7 patients based on PET/CT, showing the final diagnostic accuracy of 42.8% (3/7).

Conclusion: PET/CT was as sensitive and specific as contrast CT in detection of recurred gastric cancer except peritoneal seeding. However, additional PET/CT on contrast CT did not increase diagnostic accuracy in detection of recurred gastric cancer. Further studies are warranted to validate the role of PET/CT in detection of gastric cancer recurrence.

Show MeSH
Related in: MedlinePlus