Added value of pretreatment (18)F-FDG PET/CT for staging of advanced gastric cancer: Comparison with contrast-enhanced MDCT

Eur J Radiol. 2016 May;85(5):989-95. doi: 10.1016/j.ejrad.2016.03.003. Epub 2016 Mar 4.

Abstract

Purpose: To evaluate the added clinical value of pretreatment (18)F-FDG PET/CT compared with conventional contrast-enhanced multidetector-row CT (CECT) alone for staging of advanced gastric cancer

Materials and methods: We studied 106 patients with locally advanced gastric cancer who underwent pretreatment CECT and (18)F-FDG PET/CT. Two experienced reviewers assessed the diagnostic performance of both CECT alone and the combination of CECT and (18)F-FDG PET/CT for the primary tumor, regional lymph node metastasis (N) and distant metastasis (M), rating their diagnostic confidence with a 5-point scoring system for each location. The two methods were compared using receiver operating characteristic (ROC) curve analysis for histopathologic findings, imaging, and clinical follow-up as the reference standards.

Results: Among the 106 patients, 96 primary tumors (90.6%) were detected by CECT, while 101 (95.3%) were clearly identified by (18)F-FDG PET/CT (p=0.074). Patient-based areas under the ROC curves for CECT alone versus the combination of CECT and (18)F-FDG PET/CT for diagnosis of N stage, peritoneal dissemination, liver metastasis, distant lymph node metastasis, bone metastasis, metastasis at other sites and overall M stage were 0.787 vs. 0.858 (p=0.13), 0.866 vs. 0.878 (p=0.31), 0.998 vs. 1.0 (p=0.36), 0.744 vs. 0.865 (p=0.049), 0.786 vs. 0.998 (p=0.034), 0.944 vs. 0.984 (p=0.34), and 0.889 vs. 0.912 (p=0.21), respectively. The diagnostic performance of primary tumor detection and NM staging was not influenced by the histologic subtype.

Conclusion: Adding (18)F-FDG PET/CT to CECT provides better diagnostic accuracy for detection of distant lymph node metastasis and bone metastasis in patients with untreated advanced gastric cancer.

Keywords: FDG; Gastric cancer; PET/CT; Staging.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / secondary
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Multidetector Computed Tomography / methods*
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography / methods*
  • ROC Curve
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Stomach Neoplasms / diagnostic imaging*
  • Stomach Neoplasms / pathology

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18