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

• Published in: Annals of surgical oncology 2018-06, Vol.25 (6), p.1633-1639
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Aged; Computed tomography; Endoscopy; Endoscopy, Gastrointestinal; Female; Fluorodeoxyglucose F18; Gastrectomy; Gastric cancer; Gastrointestinal Oncology; Humans; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Neoplasm Staging; Oncology; Patients; Positron emission tomography; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Preoperative Period; Radiopharmaceuticals; Retrospective Studies; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Tomography
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6455-0

Background Preoperative precise staging is essential for the treatment of gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be increased. The present study investigated the clinical value of positron emission tomography-computed tomography (PET-CT) for the staging of GC. Methods This was a retrospective study of 117 patients with a clinical diagnosis of advanced GC who underwent PET-CT followed by gastrectomy. The incidence of FDG uptake in the primary tumor or lymph nodes and its relationship with clinicopathological factors, particularly pathological stage (pStage) III/IV, were examined. Results FDG uptake in the primary tumor was noted in 83 patients (70.9%). FDG uptake in the lymph nodes was detected in 21 patients (17.9%), and its sensitivity and specificity for lymph node metastasis were 22.7 and 90.5%, respectively. Multiple logistic regression analyses showed that FDG uptake in the primary tumor (odds ratio (OR) 2.764; 95% confidence interval (CI) 1.104–7.459, p  = 0.029) and that in the lymph nodes (OR 4.660; 95% CI 1.675–13.84, p  = 0.003) were factors independently associated with pStage III/IV. FDG uptake in the primary tumor detected pStage III/IV with higher sensitivity (80.4%) and that in lymph nodes found pStage III/IV with higher specificity (88.7%) than those of upper endoscopy plus CT (60.9 and 67.6%, respectively). Conclusions 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.