Skip to main content

Advertisement

SpringerLink
Log in

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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

    Article  CAS  PubMed  Google Scholar 

  2. Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29(33):4387–93.

    Article  CAS  PubMed  Google Scholar 

  3. Bang Y-J, Kim Y-W, Yang H-K, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379(9813):315–21.

    Article  CAS  PubMed  Google Scholar 

  4. Kosuga T, Ichikawa D, Otsuji E. Pathologic tumor response to neoadjuvant chemotherapy in gastroesophageal cancer: what does it mean? Transl Gastroenterol Hepatol. 2016;1:75.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schuhmacher C, Gretschel S, Lordick F, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol. 2010;28(35):5210–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boige V, Pignon JP. Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. ASCO Annual Meeting. 2007.

  7. Iwasaki Y, Sasako M, Yamamoto S, et al. Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol. 2013;107(7):741–5.

    Article  CAS  PubMed  Google Scholar 

  8. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol. 2007;25(15):2107–16.

    Article  PubMed  Google Scholar 

  9. Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer. 2009;12(1):6–22.

    Article  CAS  PubMed  Google Scholar 

  10. Serrano OK, Love C, Goldman I, et al. The value of FDG-PET in the staging of gastric adenocarcinoma: a single institution retrospective review. J Surg Oncol. 2016;113(6):640–6.

    Article  PubMed  Google Scholar 

  11. Li P, Liu Q, Wang C, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer after surgical resection: a systematic review and meta-analysis. Anna Nuclear Med. 2016;30(3):179–87.

    Article  Google Scholar 

  12. Kudou M, Shiozaki A, Fujiwara H, et al. Efficacy of PET-CT in the diagnosis and treatment of recurrence after esophageal cancer Surgery. Anticancer Res. 2016;36(10):5473–80.

    Article  CAS  PubMed  Google Scholar 

  13. Pak KH, Yun M, Cheong JH, Hyung WJ, Choi SH, Noh SH. Clinical implication of FDG-PET in advanced gastric cancer with signet ring cell histology. J Surg Oncol. 2011;104(6):566–70.

    Article  PubMed  Google Scholar 

  14. Shimada H, Okazumi S, Koyama M, Murakami K. Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer. 2011;14(1):13–21.

    Article  PubMed  Google Scholar 

  15. Yang DM, Kim HC, Jin W, et al. 64 multidetector-row computed tomography for preoperative evaluation of gastric cancer: histological correlation. J Comp Assist Tomogr. 2007;31(1):98–103.

    Article  Google Scholar 

  16. Hasegawa S, Yoshikawa T, Shirai J, et al. A prospective validation study to diagnose serosal invasion and nodal metastases of gastric cancer by multidetector-row CT. Ann Surg Oncol. 2013;20(6):2016–22.

    Article  PubMed  Google Scholar 

  17. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edn. Gastric Cancer. 2011;14(2):101–12.

  18. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.

    Article  Google Scholar 

  19. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.

    Article  Google Scholar 

  20. Kim HW, Won KS, Song BI, Kang YN. Correlation of primary tumor FDG uptake with histopathologic features of advanced gastric cancer. Nucl Med Mol Imaging. 2015;49(2):135–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kaneko Y, Murray WK, Link E, Hicks RJ, Duong C. Improving patient selection for 18F-FDG PET scanning in the staging of gastric cancer. J Nucl Med. 2015;56(4):523–9.

    Article  CAS  PubMed  Google Scholar 

  22. Fukagawa T, Katai H, Mizusawa J, et al. A prospective multi-institutional validity study to evaluate the accuracy of clinical diagnosis of pathological stage III gastric cancer (JCOG1302A). Gastric Cancer. 2018;21(1):68–73.

    Article  PubMed  Google Scholar 

  23. Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. The Cochrane database of systematic reviews. 2015(2):Cd009944.

  24. Grabinska K, Pelak M, Wydmanski J, Tukiendorf A, d’Amico A. Prognostic value and clinical correlations of 18-fluorodeoxyglucose metabolism quantifiers in gastric cancer. World J Gastroenterol. 2015;21(19):5901–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Park JC, Lee JH, Cheoi K, et al. Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor. Eur J Nucl Med Mol Imaging. 2012;39(7):1107–16.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Michihiro Kudou MD, PhD, Toshiyuki Kosuga MD, PhD, Takeshi Kubota MD, PhD, Kazuma Okamoto MD, PhD, Shuhei Komatsu MD, PhD, Katsutoshi Shoda MD, PhD, Hirotaka Konishi MD, PhD, Atsushi Shiozaki MD, PhD, Hitoshi Fujiwara MD, PhD, Tomohiro Arita MD, PhD, Ryo Morimura MD, PhD, Yasutoshi Murayama MD, PhD, Yoshiaki Kuriu MD, PhD, Hisashi Ikoma MD, PhD, Masayoshi Nakanishi MD, PhD & Eigo Otsuji MD, PhD

  2. Department of Gastroenterological Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Shuhei Komatsu MD, PhD

Authors
  1. Michihiro Kudou MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshiyuki Kosuga MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Kubota MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuma Okamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuhei Komatsu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsutoshi Shoda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hirotaka Konishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Atsushi Shiozaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hitoshi Fujiwara MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomohiro Arita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryo Morimura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasutoshi Murayama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yoshiaki Kuriu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hisashi Ikoma MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Masayoshi Nakanishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Eigo Otsuji MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshiyuki Kosuga MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kudou, M., Kosuga, T., Kubota, T. et al. Value of Preoperative PET-CT in the Prediction of Pathological Stage of Gastric Cancer. Ann Surg Oncol 25, 1633–1639 (2018). https://doi.org/10.1245/s10434-018-6455-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6455-0

Keywords

Search

Navigation