FDG-PET has no definite role in preoperative imaging in gastric cancer

Eur J Surg Oncol. 2009 May;35(5):449-55. doi: 10.1016/j.ejso.2008.11.010. Epub 2009 Jan 14.


Background: Gastric cancer is fourth on the incidence list of cancers worldwide with a high disease-related mortality rate. Curation can only be achieved by a radical resection including an adequate lymphadenectomy. However, prognosis remains poor and cancer recurrence rates are high, also due to lymph node metastases. To improve outcome, (neo)adjuvant treatment strategies with chemo- and/or radiotherapy regimes are employed.

Aims: Accurate staging of gastric cancer at primary diagnosis is essential for adequate treatment. In this non-systematic review the role 18-F-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in preoperative staging is investigated. Furthermore, the results of neoadjuvant chemotherapy-induced tumour response monitoring by FDG-PET are discussed.

Results and conclusion: It is concluded that currently FDG-PET has no role in the primary detection of gastric cancer due to its low sensitivity. FDG-PET shows, however, slightly better results in the evaluation of lymph node metastases in gastric cancer compared to CT and could have therefore a role in the preoperative staging. Improvement in accuracy could be achieved by using PET/CT or other PET tracers than FDG, but these modalities need further investigation. FDG-PET, however, adequately detects therapy responders at an early stage following neoadjuvant chemotherapy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Chemotherapy, Adjuvant
  • Fluorodeoxyglucose F18*
  • Humans
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Preoperative Care
  • Radiopharmaceuticals*
  • Sensitivity and Specificity
  • Stomach Neoplasms / diagnostic imaging*
  • Stomach Neoplasms / drug therapy
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery
  • Tomography, Emission-Computed / methods*


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18