Limits...
18F-2-Deoxy-2-Fluoro-D-Glucose Positron Emission Tomography: Computed Tomography for Preoperative Staging in Gastric Cancer Patients.

Youn SH, Seo KW, Lee SH, Shin YM, Yoon KY - J Gastric Cancer (2012)

Bottom Line: The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity.There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value.Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT

Purpose: The use of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography-computed tomography as a routine preoperative modality is increasing for gastric cancer despite controversy with its usefulness in preoperative staging. In this study we aimed to determine the usefulness of preoperative positron emission tomography-computed tomography scans for staging of gastric cancer.

Materials and methods: We retrospectively analyzed 396 patients' positron emission tomography-computed tomography scans acquired for preoperative staging from January to December 2009.

Results: The sensitivity of positron emission tomography-computed tomography for detecting early gastric cancer was 20.7% and it was 74.2% for advanced gastric cancer. The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity. For regional lymph node metastasis, the sensitivity and specificity of the positron emission tomography-computed tomography were 30.7% and 94.7%, respectively. There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value. Fluorodeoxyglucose uptake was detected by positron emission tomography-computed tomography in 24 lesions other than the primary tumors. Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers. Only two cases were detected purely by positron emission tomography-computed tomography.

Conclusions: Positron emission tomography-computed tomography could be useful in detecting metastasis or another primary cancer for preoperative staging in gastric cancer patients, but not for T or N staging. More prospective studies are needed to determine whether positron emission tomography-computed tomography scans should be considered a routine preoperative imaging modality.

No MeSH data available.


Related in: MedlinePlus

Correlation between SUVmax and T stage (R2=0.05). SUVmax = maximum standardized uptake value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3473225&req=5

Figure 1: Correlation between SUVmax and T stage (R2=0.05). SUVmax = maximum standardized uptake value.

Mentions: Endoscopic findings indicated early gastric cancer in 237 of the 396 patients and advanced gastric cancer in the remaining 159. PET-CT findings were positive in 49 of the 237 early gastric cancer patients (20.7%) and in 118 of the advanced gastric cancer patients (74.2%), indicating that PET-CT is more sensitive for detecting advanced gastric cancer. We could not find considerable differences between those results and results of T-staging according to pathologic findings. Among the advanced gastric cancers, the sensitivities of positive uptake on PET-CT were 75%, 73.9%, 76% and 69.2% for Borrmann type I, II, III and IV, respectively, and P-value was 0.967 (Table 2). We found that the sensitivity of PET-CT for T staging was 11.9% for T1a (13/109), 27.5% for T1b (30/109), 55.4% for T2 (31/56), 71.4% for T3 (35/49), 76.5% for T4a (39/51) and 88.9% for T4b (16/18), suggesting that the sensitivity of this modality increases with T stage and it had <0.001 of P-value (Table 2). Sensitivities in terms of primary lesion size were 18.5% for lesions less than 1 cm (10/54), 23.9% for those 1~3 cm (39/163) and 65.9% for lesions larger than 3 cm (118/179) (Table 2). P-value was <0.001. These finding indicate that the sensitivity of PET-CT is influenced by the T stage and the size of the primary lesion. Thus, we assessed the statistical relationship between the T stage and maximum standardized uptake value (SUVmax) to define the T stage. We found that as the T stage increased to T4b, SUVmax also increased and the value of R2 was 0.05 (Fig. 1). We determined the relationship between the WHO pathologic classification and uptake on PET-CT and found that 81 of 199 cases were the differentiated type and 79 of 187 were the undifferentiated type (Table 2). In terms of the Lauren pathologic classification, the sensitivity of PET-CT for detecting the intestinal type was 47.1% (114/242), 27.9% (29/103) for the diffuse type, 39.4% (13/33) for the mixed type and 64.7% (11/17) for the unknown type, which included O&C cases. The P-value was 0.002 (Table 2).


18F-2-Deoxy-2-Fluoro-D-Glucose Positron Emission Tomography: Computed Tomography for Preoperative Staging in Gastric Cancer Patients.

Youn SH, Seo KW, Lee SH, Shin YM, Yoon KY - J Gastric Cancer (2012)

Correlation between SUVmax and T stage (R2=0.05). SUVmax = maximum standardized uptake value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473225&req=5

Figure 1: Correlation between SUVmax and T stage (R2=0.05). SUVmax = maximum standardized uptake value.
Mentions: Endoscopic findings indicated early gastric cancer in 237 of the 396 patients and advanced gastric cancer in the remaining 159. PET-CT findings were positive in 49 of the 237 early gastric cancer patients (20.7%) and in 118 of the advanced gastric cancer patients (74.2%), indicating that PET-CT is more sensitive for detecting advanced gastric cancer. We could not find considerable differences between those results and results of T-staging according to pathologic findings. Among the advanced gastric cancers, the sensitivities of positive uptake on PET-CT were 75%, 73.9%, 76% and 69.2% for Borrmann type I, II, III and IV, respectively, and P-value was 0.967 (Table 2). We found that the sensitivity of PET-CT for T staging was 11.9% for T1a (13/109), 27.5% for T1b (30/109), 55.4% for T2 (31/56), 71.4% for T3 (35/49), 76.5% for T4a (39/51) and 88.9% for T4b (16/18), suggesting that the sensitivity of this modality increases with T stage and it had <0.001 of P-value (Table 2). Sensitivities in terms of primary lesion size were 18.5% for lesions less than 1 cm (10/54), 23.9% for those 1~3 cm (39/163) and 65.9% for lesions larger than 3 cm (118/179) (Table 2). P-value was <0.001. These finding indicate that the sensitivity of PET-CT is influenced by the T stage and the size of the primary lesion. Thus, we assessed the statistical relationship between the T stage and maximum standardized uptake value (SUVmax) to define the T stage. We found that as the T stage increased to T4b, SUVmax also increased and the value of R2 was 0.05 (Fig. 1). We determined the relationship between the WHO pathologic classification and uptake on PET-CT and found that 81 of 199 cases were the differentiated type and 79 of 187 were the undifferentiated type (Table 2). In terms of the Lauren pathologic classification, the sensitivity of PET-CT for detecting the intestinal type was 47.1% (114/242), 27.9% (29/103) for the diffuse type, 39.4% (13/33) for the mixed type and 64.7% (11/17) for the unknown type, which included O&C cases. The P-value was 0.002 (Table 2).

Bottom Line: The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity.There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value.Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT

Purpose: The use of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography-computed tomography as a routine preoperative modality is increasing for gastric cancer despite controversy with its usefulness in preoperative staging. In this study we aimed to determine the usefulness of preoperative positron emission tomography-computed tomography scans for staging of gastric cancer.

Materials and methods: We retrospectively analyzed 396 patients' positron emission tomography-computed tomography scans acquired for preoperative staging from January to December 2009.

Results: The sensitivity of positron emission tomography-computed tomography for detecting early gastric cancer was 20.7% and it was 74.2% for advanced gastric cancer. The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity. For regional lymph node metastasis, the sensitivity and specificity of the positron emission tomography-computed tomography were 30.7% and 94.7%, respectively. There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value. Fluorodeoxyglucose uptake was detected by positron emission tomography-computed tomography in 24 lesions other than the primary tumors. Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers. Only two cases were detected purely by positron emission tomography-computed tomography.

Conclusions: Positron emission tomography-computed tomography could be useful in detecting metastasis or another primary cancer for preoperative staging in gastric cancer patients, but not for T or N staging. More prospective studies are needed to determine whether positron emission tomography-computed tomography scans should be considered a routine preoperative imaging modality.

No MeSH data available.


Related in: MedlinePlus