PURPOSE: The aim of this study was to assess the diagnostic accuracy of (18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with respect to lymph node (LN) metastasis in patients with advanced gastric cancer, and to ascertain the factors that affect this accuracy. METHODS: Seventy-three patients with advanced gastric cancer, verified in all cases by endoscopic biopsy, were enrolled in this prospective study. We conducted FDG PET and other routine preoperative studies, including abdominal computed tomography (CT). Patients underwent either curative-intent gastrectomy and lymphadenectomy (n = 67) or exploratory laparotomy. The Japanese system for the classification of gastric cancer was used for LN assessment. RESULTS: FDG PET was able to detect primary lesions in 70 of the 73 cases. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value of FDG PET for LN metastasis were 40%, 95%, 91% and 56%, respectively. Signet-ring cell carcinoma was associated with the lowest sensitivity (15%), whereas other cell types could be detected with moderate sensitivity (30-71%) and high specificity (93-100%). According to multiple logistic regression, the standardised uptake value for primary tumours was the only independent variable to be significantly related to sensitivity for LN metastasis (p = 0.02, odds ratio = 1.14). CT was superior to PET in terms of sensitivity (p < 0.0001), and PET was superior to CT in terms of specificity (p < 0.0001) and PPV (p = 0.05). CONCLUSION: FDG PET exhibits good specificity for LN staging of gastric cancer, and FDG uptake in the primary tumour is significantly related to the accuracy of FDG PET. Despite some clear limitations, FDG PET proved useful in the LN staging of FDG-avid gastric cancer.
PURPOSE: The aim of this study was to assess the diagnostic accuracy of (18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with respect to lymph node (LN) metastasis in patients with advanced gastric cancer, and to ascertain the factors that affect this accuracy. METHODS: Seventy-three patients with advanced gastric cancer, verified in all cases by endoscopic biopsy, were enrolled in this prospective study. We conducted FDG PET and other routine preoperative studies, including abdominal computed tomography (CT). Patients underwent either curative-intent gastrectomy and lymphadenectomy (n = 67) or exploratory laparotomy. The Japanese system for the classification of gastric cancer was used for LN assessment. RESULTS: FDG PET was able to detect primary lesions in 70 of the 73 cases. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value of FDG PET for LN metastasis were 40%, 95%, 91% and 56%, respectively. Signet-ring cell carcinoma was associated with the lowest sensitivity (15%), whereas other cell types could be detected with moderate sensitivity (30-71%) and high specificity (93-100%). According to multiple logistic regression, the standardised uptake value for primary tumours was the only independent variable to be significantly related to sensitivity for LN metastasis (p = 0.02, odds ratio = 1.14). CT was superior to PET in terms of sensitivity (p < 0.0001), and PET was superior to CT in terms of specificity (p < 0.0001) and PPV (p = 0.05). CONCLUSION: FDG PET exhibits good specificity for LN staging of gastric cancer, and FDG uptake in the primary tumour is significantly related to the accuracy of FDG PET. Despite some clear limitations, FDG PET proved useful in the LN staging of FDG-avid gastric cancer.
Authors: Sonia J Wakelin; Chris Deans; Trevor J Crofts; Paul L Allan; John N Plevris; Simon Paterson-Brown Journal: Eur J Radiol Date: 2002-02 Impact factor: 3.528
Authors: K Ziegler; C Sanft; T Zimmer; M Zeitz; D Felsenberg; H Stein; C Germer; C Deutschmann; E O Riecken Journal: Gut Date: 1993-05 Impact factor: 23.059
Authors: Mi-Jung Lee; Mi Jin Yun; Mi-Suk Park; Seung Hwan Cha; Myeong-Jin Kim; Jong Doo Lee; Ki Whang Kim Journal: World J Gastroenterol Date: 2009-09-21 Impact factor: 5.742