Elsevier

Clinical Positron Imaging

Volume 1, Issue 4, Autumn 1998, Pages 213-221
Clinical Positron Imaging

Original article
Accuracy of FDG-PET in Gastric Cancer: Preliminary Experience☆

https://doi.org/10.1016/S1095-0397(98)00018-1Get rights and content

Abstract

Objective: Currently available imaging modalities, including CT, ultrasound, and MRI are unsatisfactory in the detection of metastatic gastric cancer, especially lymph node metastases and peritoneal spread. The aim of this study is to evaluate FDG-PET in the diagnosis of primary as well as metastatic gastric cancer.

Method: All patients (18M/5F; mean age 62, range 33–81) with gastric cancer referred for FDG-PET scan from 1/1/97 to 3/20/98 were studied. PET images of the neck, chest, and abdomen were acquired using a dedicated whole body scanner. A final diagnosis was reached in 21 patients by histology, surgical findings, or clinical follow-up.

Results: All but 1 primary tumor (12 out of 13) and both cases with local recurrence showed a high degree of FDG uptake, with mean SUV of 8.9 (range 4.8–17.6). The one false negative (FN) occurred in a poorly controlled diabetic with blood sugar of >400 at the time of study. Six cases with prior gastrectomy were true negative (TN) in the region of the stomach. This translates to a sensitivity of 93%, specificity of 100%, and accuracy of 95% for the primary site. In contrast, for intra-abdominal lymph node (LN) stations PET was true positive (TP) in 2, FN in 7, false positive (FP) in 1, and TN in 32, yielding a sensitivity of 22% and accuracy of 81%. PET detected only 2 out of 9 perigastric lymph node metastases. For the 8 patients in this series who had documented M1 disease, PET detected two with liver metastasis, one with colon metastasis, and one with submandibular LN. However, four cases of peritoneal spread were missed.

Conclusion: FDG-PET is highly sensitive in detecting the primary lesion in gastric cancer and shows promise in the detection of liver and extra-abdominal metastasis. However, PET appears limited in the detection of perigastric lymphadenopathy as distinct from the primary tumor and in assessing peritoneal spread. Our preliminary assessment suggests that staging of gastric cancer with FDG-PET scanning is relatively effective at detecting distant metastatic disease and will complement standard staging methods such as laparoscopy, which are more effective at staging local nodal spread and peritoneal disease.

Section snippets

Method

All patients (18M/5F; mean age 62, range 33–81) with gastric cancer referred for FDG-PET scan from 1/1/97 to 3/20/98 were studied. The clinical indications were pre-operative staging in 13 patients, evaluation of possible recurrence in 6 patients, and staging of recurrence in 4 patients. All patients were instructed to fast for at least 6 hours. Whole body PET images were acquired on a GE Advance scanner (35 image planes, 4.25 mm/slice, 15 cm AFOV) 45 minutes to 1 hour after the intravenous

Results

The patient and PET data are shown in Table 1. The PET findings of the primary sites are shown in Table 2 and that of the intra-abdominal lymph nodes in Table 3.

For the primary site, FDP-PET was highly accurate. All but 1 primary tumor (12 out of 13) and the 2 cases with local anastomotic recurrence showed a high degree of FDG uptake, with SUV ranging from 4.6 to 17.6 (mean 8.0). A typical FDG-PET scan of gastric cancer is shown in Figure 1, demonstrating the high contrast between the tumor and

Discussion

Similar to other gastrointestinal malignancies such as cancer of the esophagus and colon, gastric cancer also appears to have high avidity for FDG. This is evident in this series of patients where all but one primary lesion and local recurrence show a high degree of FDG uptake. This is also in agreement with the findings of Herrington et al. who presented their findings at the Annual Meeting of the Society of Nuclear Medicine in 1997.22 The only case of false negative was in a patient with

Conclusion

This pilot study shows that FDG-PET is highly sensitive in detecting the primary lesion in gastric cancer. There is preliminary indication that FDG-PET scan is sensitive for detecting metastasis to liver and extra-abdominal sites but appears limited in the detection of perigastric lymphadenopathy and intra-peritoneal spread. However, PET and laparoscopy may play complementary roles in the detection of M1 disease, and together would be able to detect most of the metastastic disease. A larger

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    ☆

    We attest that we have herein disclosed any and all financial or other relationships that could be construed as a conflict of interest, and that all sources of financial support for this study have been disclosed and are indicated in Acknowledgments.

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