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Yoon, Park, Jung, Cho, Lee, Choi, Chung, Song, and Park: Usefulness of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Evaluation of Gastric Cancer Stage
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(5): 347-353.

Published online: 21 May 2012

DOI: https://doi.org/10.4166/kjg.2012.59.5.347

Usefulness of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Evaluation of Gastric Cancer Stage

Na Ri Yoon, Jae Myung Park, Hee Sun Jung, Yu Kyung Cho, In Seok Lee, Myung-Gyu Choi, In-Sik Chung, Kyo Young Song1, Cho Hyun Park1

Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.

1Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Correspondence to: Jae Myung Park, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, 222 Banpodae-ro, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6023, Fax: +82-2-2258-2055, parkjerry@catholic.ac.kr

Received 18 July 2011       Revised 25 October 2011       Accepted 5 December 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The usefulness of 18F-fluoro-2-deoxyglucose (FDG)-PET in detecting primary cancer, lymph node metastasis, and distant metastasis were studied in the gastric cancer patients.

Methods

The subjects were 392 gastric cancer patients who received FDG-PET and an abdominal CT test prior to surgery. The results of FDG-PET and CT were compared with the surgical and pathologic results.

Results

The primary site detection rate of FDG-PET was 74.4%, 50.3% in early gastric cancer and 92.0% in advanced gastric cancer. Detection rate was higher when tumors were larger than 3.5 cm, had deeper depth of invasion, and at a later stage (p<0.05, respectively). In multivariate analysis, tumor size, spread of tumor cells beyond the muscle layer (≥T2), and lymph node metastasis were statistically significant factors in primary site detection rate. The sensitivity, specificity, and positive predictive value of FDG-PET to lymph node metastasis were 59.6%, 88.8%, and 81.1% respectively, sensitivity being lower compared to CT while specificity and positive predictive value were higher. Sensitivity, specificity, and positive predictive value to distant metastasis were, respectively, 66.7%, 99.2%, and 88.0%, similar to CT. In 21 of the 392 patients (5.4%), synchronous double primary cancers were detected.

Conclusions

In gastric cancer, usefullness of FDG-PET is limited to the advanced stage. Diagnostic value of this test was not superior to CT. However, FDG-PET may be useful in detecting synchronous double primary cancers.

Keywords: Stomach neoplasms, Fluorodeoxyglucose F18, Positron-emission tomography, Lymph nodes, Neoplasm metastasis

Figures and Tables

Fig. 1
Detection rate of gastric cancer with 18F-fluoro-2-deoxyglucose (FDG)-PET according to tumor size.
ROC, receiver operating characteristic.
kjg-59-347-g001
Table 1
Characteristics of Study Population and Clinicopathologic Findings
kjg-59-347-i001

aAccording to the 6th Union International Contra la Cancrum classification.

Table 2
Gastric Cancer Detection Rate according to Clinicopathologic Parameters
kjg-59-347-i002

Numbers in parentheses are percentages.

FDG, 18F-fluoro-2-deoxyglucose; EGC, early gastric cancer; AGC, advanced gastric cancer.

a26 cases are missing; baccording to the 6th Union International Contra la Cancrum classification.

Table 3
Logistic Regression Model for Factors Influencing Detection Rate of Primary Gastric Cancer in FDG-PET
kjg-59-347-i003

FDG, 18F-fluoro-2-deoxyglucose.

Table 4
Diagnostic Yields of FDG-PET and CT for Detection of Lymph Node and Distant Metastasis in Gastric Cancer
kjg-59-347-i004

FDG, 18F-fluoro-2-deoxyglucose; PPV, positive predictive value; NPV, negative predictive value.

Notes

Financial support: This research was supported by Seoul St. Mary's Clinical Medicine Research Program year of 2009 through the Catholic University of Korea.

Conflict of interest: None.

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