Yusuke Kawanaka1, Kazuhiro Kitajima2, Kazuhito Fukushima3, Miya Mouri4, Hiroshi Doi5, Tsutomu Oshima6, Hirotaka Niwa7, Nobuaki Kaibe8, Mitsuru Sasako9, Toshihiko Tomita10, Hiroto Miwa11, Shozo Hirota12. 1. Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: n_you_634@yahoo.co.jp. 2. Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: kazu10041976@yahoo.co.jp. 3. Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: fukuchan0106@gmail.com. 4. Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: m-mou@hyo-med.ac.jp. 5. Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: h-doi@hyo-med.ac.jp. 6. Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: tsutomu@hyo-med.ac.jp. 7. Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: hironiwa@hyo-med.ac.jp. 8. Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: kaibe-2s@hyo-med.ac.jp. 9. Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: msasako@hyo-med.ac.jp. 10. Division of Gastroenterology, Department of Internal medicine, Hyogo College of Medicine, Japan. Electronic address: tomita@hyo-med.ac.jp. 11. Division of Gastroenterology, Department of Internal medicine, Hyogo College of Medicine, Japan. Electronic address: miwahgi@hyo-med.ac.jp. 12. Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: hirota-s@hyo-med.ac.jp.
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.
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.
Authors: Alicia S Borggreve; Lucas Goense; Hylke J F Brenkman; Stella Mook; Gert J Meijer; Frank J Wessels; Marcel Verheij; Edwin P M Jansen; Richard van Hillegersberg; Peter S N van Rossum; Jelle P Ruurda Journal: Br J Radiol Date: 2019-03-05 Impact factor: 3.039