Галерея 3148984
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World J Surg Oncol
v.9; 2011
PMC3148984
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Published online 2011 Jul 14. doi: 10.1186/1477-7819-9-75
1 From the Department of Nuclear Medicine, Ankara University, Medical Faculty, Ankara, Turkey
Received 2011 Feb 16; Accepted 2011 Jul 14.
Copyright ©2011 Ozkan et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Gastric cancer, FDG-PET/CT, spiral CT
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55 (2):74–108. doi: 10.3322/canjclin.55.2.74. [ PubMed ] [ CrossRef ] [ Google Scholar ] Chandanos E, Lagergren J. Oestrogen and the enigmatic male predominance of gastric cancer. Eur J Cancer. 2008; 44 (16):2397–403. doi: 10.1016/j.ejca.2008.07.031. [ PubMed ] [ CrossRef ] [ Google Scholar ] Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001; 49 (4):534–539. doi: 10.1136/gut.49.4.534. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ] Willis S, Truong S, Gribnitz S, Fass J, Schumpelick V. Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy. Surg Endosc. 2000; 14 (10):951–954. doi: 10.1007/s004640010040. [ PubMed ] [ CrossRef ] [ Google Scholar ] Bhandari S, Shim CS, Kim JH, Jung IS, Cho JY, Lee JS, Lee MS, Kim BS. Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology. Gastrointest Endosc. 2004; 59 (6):619–626. doi: 10.1016/S0016-5107(04)00169-5. [ PubMed ] [ CrossRef ] [ Google Scholar ] Habermann CR, Weiss F, Riecken R, Honarpisheh H, Bohnacker S, Staedtler C, Dieckmann C, Schoder V, Adam G. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004; 230 (2):465–471. doi: 10.1148/radiol.2302020828. [ PubMed ] [ CrossRef ] [ Google Scholar ] Kim KW, Choi BI, Han JK, Kim TK, Kim AY, Lee HJ, Kim YH, Choi JI, Do KH, Kim HC, Lee MW. Postoperative anatomic and pathologic findings at CT following gastrectomy. Radiographics. 2002; 22 (2):323–336. [ PubMed ] [ Google Scholar ] Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002; 224 (3):748–756. doi: 10.1148/radiol.2243011362. [ PubMed ] [ CrossRef ] [ Google Scholar ] Lynch TB. PET/CT in Clinical Practice. Springer-Verlag London; 2007. Introduction; pp. 1–15. [ Google Scholar ] Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JF, Bosscha K. FDG-PET has no definite role in preoperative imaging in gastric cancer. Eur J Surg Oncol. 2009; 35 (5):449–55. [ PubMed ] [ Google Scholar ] Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, Kim TS, Lee JD, Noh SH, Kim KW. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2006; 26 (1):143–56. doi: 10.1148/rg.261055078. [ PubMed ] [ CrossRef ] [ Google Scholar ] Kim SK, Kang W, Lee JS Kim HK, Kim HK, Chang HJ, Choi JY, Lee JH, Ryu KW, Kim YW, Bae JM. Assesment of Lymph node metastasis using 18F-FDG PET in patients with advanced gastric cancer. Eur J Nucl Med Mol Imaging. 2006; 33 (2):148–155. doi: 10.1007/s00259-005-1887-8. [ PubMed ] [ CrossRef ] [ Google Scholar ] Yun M, Lim JS, Noh SH, Hyung WJ, Cheong JH, Bong JK, Cho A, Lee JD. Lymph Node Staging of Gastric Cancer Using18F-FDG PET: A Comparison Study with CT. J Nucl Med. 2005; 46 (10):1582–1588. [ PubMed ] [ Google Scholar ] Podoloff DA, Advani RH, Allred C, Benson AB, Brown E, Burstein HJ, Carlson RW, Coleman RE, Czuczman MS, Delbeke D, Edge SB, Ettinger DS, Grannis FW Jr, Hillner BE, Hoffman JM, Kiel K, Komaki R, Larson SM, Mankoff DA, Rosenzweig KE, Skibber JM, Yahalom J, Yu JM, Zelenetz AD. NCCN Task Force Report: Positron Emission Tomography (PET)/Computed Tomography(CT) Scanning in Cancer. J Natl Compr Canc Netw. 2007; 5 (Suppl 1):S1–S22. quiz S23-2. [ PubMed ] [ Google Scholar ] Yoshioka T, Yamaguchi K, Kubota K, Saginoya T, Yamazaki T, Ido T, Yamaura G, Takahashi H, Fukuda H, Kanamaru R. Evaluation of 18F-FDG PET in patients with advanced, metastatic, or recurrent gastric cancer. J Nucl Med. 2003; 44 (5):690–9. [ PubMed ] [ Google Scholar ] Suttie SA, Welch AE, Park KG. Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastro-oesophageal junction carcinoma. Eur J Surg Oncol. 2009; 35 (10):1019–29. [ PubMed ] [ Google Scholar ] Hur H, Kim SH, Kim W, Song KY, Park CH, Jeon HM. The efficacy of preoperative PET/CT for prediction of curability in surgery for locally advanced gastric carcinoma. World J of Surg Oncol. 2010; 8 (86) [ PMC free article ] [ PubMed ] [ Google Scholar ] Fogelman I, Cook G, Israel O, Van der Wall H. Positron Emission Tomography and Bone Metastases. Semin Nucl Med. 2005; 35 :135–142. doi: 10.1053/j.semnuclmed.2004.11.005. [ PubMed ] [ CrossRef ] [ Google Scholar ]
Articles from World Journal of Surgical Oncology are provided here courtesy of BioMed Central
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55 (2):74–108. doi: 10.3322/canjclin.55.2.74. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Chandanos E, Lagergren J. Oestrogen and the enigmatic male predominance of gastric cancer. Eur J Cancer. 2008; 44 (16):2397–403. doi: 10.1016/j.ejca.2008.07.031. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001; 49 (4):534–539. doi: 10.1136/gut.49.4.534. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Willis S, Truong S, Gribnitz S, Fass J, Schumpelick V. Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy. Surg Endosc. 2000; 14 (10):951–954. doi: 10.1007/s004640010040. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Bhandari S, Shim CS, Kim JH, Jung IS, Cho JY, Lee JS, Lee MS, Kim BS. Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology. Gastrointest Endosc. 2004; 59 (6):619–626. doi: 10.1016/S0016-5107(04)00169-5. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Habermann CR, Weiss F, Riecken R, Honarpisheh H, Bohnacker S, Staedtler C, Dieckmann C, Schoder V, Adam G. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004; 230 (2):465–471. doi: 10.1148/radiol.2302020828. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Kim KW, Choi BI, Han JK, Kim TK, Kim AY, Lee HJ, Kim YH, Choi JI, Do KH, Kim HC, Lee MW. Postoperative anatomic and pathologic findings at CT following gastrectomy. Radiographics. 2002; 22 (2):323–336. [ PubMed ] [ Google Scholar ] [ Ref list ]
Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002; 224 (3):748–756. doi: 10.1148/radiol.2243011362. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Lynch TB. PET/CT in Clinical Practice. Springer-Verlag London; 2007. Introduction; pp. 1–15. [ Google Scholar ] [ Ref list ]
Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JF, Bosscha K. FDG-PET has no definite role in preoperative imaging in gastric cancer. Eur J Surg Oncol. 2009; 35 (5):449–55. [ PubMed ] [ Google Scholar ] [ Ref list ]
Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, Kim TS, Lee JD, Noh SH, Kim KW. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2006; 26 (1):143–56. doi: 10.1148/rg.261055078. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Kim SK, Kang W, Lee JS Kim HK, Kim HK, Chang HJ, Choi JY, Lee JH, Ryu KW, Kim YW, Bae JM. Assesment of Lymph node metastasis using 18F-FDG PET in patients with advanced gastric cancer. Eur J Nucl Med Mol Imaging. 2006; 33 (2):148–155. doi: 10.1007/s00259-005-1887-8. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
Podoloff DA, Advani RH, Allred C, Benson AB, Brown E, Burstein HJ, Carlson RW, Coleman RE, Czuczman MS, Delbeke D, Edge SB, Ettinger DS, Grannis FW Jr, Hillner BE, Hoffman JM, Kiel K, Komaki R, Larson SM, Mankoff DA, Rosenzweig KE, Skibber JM, Yahalom J, Yu JM, Zelenetz AD. NCCN Task Force Report: Positron Emission Tomography (PET)/Computed Tomography(CT) Scanning in Cancer. J Natl Compr Canc Netw. 2007; 5 (Suppl 1):S1–S22. quiz S23-2. [ PubMed ] [ Google Scholar ] [ Ref list ]
Yoshioka T, Yamaguchi K, Kubota K, Saginoya T, Yamazaki T, Ido T, Yamaura G, Takahashi H, Fukuda H, Kanamaru R. Evaluation of 18F-FDG PET in patients with advanced, metastatic, or recurrent gastric cancer. J Nucl Med. 2003; 44 (5):690–9. [ PubMed ] [ Google Scholar ] [ Ref list ]
Suttie SA, Welch AE, Park KG. Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastro-oesophageal junction carcinoma. Eur J Surg Oncol. 2009; 35 (10):1019–29. [ PubMed ] [ Google Scholar ] [ Ref list ]
Hur H, Kim SH, Kim W, Song KY, Park CH, Jeon HM. The efficacy of preoperative PET/CT for prediction of curability in surgery for locally advanced gastric carcinoma. World J of Surg Oncol. 2010; 8 (86) [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
Fogelman I, Cook G, Israel O, Van der Wall H. Positron Emission Tomography and Bone Metastases. Semin Nucl Med. 2005; 35 :135–142. doi: 10.1053/j.semnuclmed.2004.11.005. [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Ref list ]
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1 From the Department of Nuclear Medicine, Ankara University, Medical Faculty, Ankara, Turkey
1 From the Department of Nuclear Medicine, Ankara University, Medical Faculty, Ankara, Turkey
1 From the Department of Nuclear Medicine, Ankara University, Medical Faculty, Ankara, Turkey
1 From the Department of Nuclear Medicine, Ankara University, Medical Faculty, Ankara, Turkey
The aim of this study was to investigate the role of F-18 fluoro-deoxy-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in the preoperative and posttherapy restaging of gastric cancer and to compare with spiral computerized tomography (CT).
A total of 42 PET/CT scans of 36 gastric cancer patients (28M, 8F; mean age: 56,0 ± 15) were included in the study. A retrospective analysis of the PET/CT results of the patients were compared with concurrent CT results. Confirmation was made by clinical course and serial imaging studies in the follow up. The compatibility ratios were calculated and the accuracy of the PET/CT was assessed. Agreement between PET/CT and concurrent CT was calculated using kappa statistics.
Patients were separated into 3 groups: the patients who were referred to our clinic for preoperative staging (4 patients), for posttherapy evaluation (24 patients) and for the suspicion of local recurrence and/or metastasis exploration after a disease free period (8 patients). Groups 1 and 3 included a small number of patients so they were omitted from the statistical analysis. Focusing on Goup 2, the overall concordance rate was 50% (12 patients). Region based analysis showed the rates of concordance for local recurrence, local lymph node metastasis and distant metastasis were 91% (Kappa: 0.70), 95% (Kappa:0.86) and 50% (Kappa:0.26) respectively. Distant metastases were also investigated in detail and the two techniques showed a concordance of 91% (Kappa: 0.75) for liver, 79%(Kappa:0.31) for distant lymph node, 79% (0.42) for lung, 87%(Kappa:0.33) for bone and 95% for intestinal wall metastasis.
PET/CT is a complementary imaging method which can be successfully used in both preoperative and posttherapy evaluation of gastric cancer.
Gastric cancer is the fourth most frequent type of cancer and 934.000 new cases arise each year worldwide [ 1 ]. Japan, China, East Europe and Latin America are reported as areas of high incidence of gastric cancer. The survival rates are generally very low because the patients usually have a high stage disease at diagnosis [ 2 ].
The only curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The evaluation of tumor resectability, local lymph node and regional solid organ and distant metastasis in the preoperative stage plays a crucial role in terms of planning a true surgery or avoiding unnecessary surgical interventions in high stage patients. Computed Tomography (CT) is frequently used for preoperative staging in gastric cancer patients. Endoscopic ultrasonography (USG) is known to be the most reliable method in the preoperative T staging of the disease [ 3 , 4 ]. However, the high technology multislice CT systems are reported to give results as accurate as endoscopic USG [ 5 , 6 ]. For nodal staging and evaluation of distant metastasis, spiral CT is also currently the method of choice in the preoperative stage [ 7 ]
In gastric cancer patients, detecting the recurrences is hard in the posttherapy follow up period. An elevation in the tumor markers like carcinoembryonic antigen (CEA) and Ca19-9 may help but there is still a need of a reliable method for the localization of recurrence. CT is the preferred method for this aim. However it is reported that CT has a limited value in the evaluation of the postoperative changes [ 7 ]. To determine the therapy response, the volumetric changes on CT is similarly used in the routine procedure. But especially in the detecion of the response in the primary tumor, these changes may not always be realized accurately [ 7 ]. When it comes to the detection of the solid organ and especially distant metastasis, although CT is currently used, there are some reports showing that as a whole body imaging method, Positron Emission Tomography (PET) is superior to anatomic imaging tools. But the role of 18F-Fluorodeoxyglucose (FDG)-PET/CT in the diagnosis of distant lymph node, bone or lung metastasis is uncertain [ 8 ].
18F-FDG-PET is a functional imaging method detecting the metabolically active tumor. It is well known that the primary energy source for cancer cells is glucose. Active tumor cells have an uncontrolled growth and division and therefore their metabolism mostly depend on anaerobic respiration which requires a greater amount of glucose consumption compared to the healthy tissues. FDG enters into the cell and is phosphorylated by hexokinase activity but can no longer be metabolized. Therefore it is trapped in the cell. Highly active malignant cells concentrate more FDG than normal tissues which provides the functional imaging in cancer patients. Hybrid PET/CT systems provide fusion images combining functional and anatomic imaging together [ 9 ].
The aim of this study was to investigate the role of F-18 fluoro-deoxy-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in the preoperative and posttherapy restaging of gastric cancer and to compare with conventional CT.
In this retrospective analysis, we reviewed a total of 51 PET/CT reports of 44 primary gastric adenocarcinoma patients to whom PET/CT was performed in the preoperative stage or for posttherapy restaging between January 2007 and January 2010. We used the clinical follow up registery of our hospital in order to reach the reports of their conventional imaging examinations and other investigations. We couldn't get the results of the medical examinations of 8 of these patients (a total of 9 PET/CT scans) who were referred only for PET/CT scan to our centre. They were omitted from the study. As a result, 36 gastric cancer patients (28M, 8F; mean age:56,0 ± 15) and 42 PET/CT reports were included in the study. 5 patients have undergone at least 2 PET/CT scans. The concurrent thoracoabdominal CT results were compared with the PET/CT results. Also, some of them had undergone additional imaging examinations like USG, Magnetic resonance imaging (MRI) or bone scintigraphy; so they were also taken under consideration. Confirmation was made by clinical course and serial imaging tests.
The subjects were divided into three groups. 4/42 of the analysed scans were performed for preoperative staging (group 1), 30/42 of the for posttherapy restaging (Group 2) and 8/42 for recurrence or metastasis search because of tumor marker elevation in the disease free follow up period (Group 3). Groups 1, 2 and 3 included 4, 24 and 8 patients respectively.
All spiral thoracoabdominal CT examinations were performed with oral and i.v. contrast agents. PET/CT imaging was done using the GE Discovery ST- 8 slices scanner. PET scans were performed after 6 hours of fasting. Blood glucose levels were checked just before the procedure. Average 296-370 MBq (8-10 mCi) FDG were injected intravenously and images were obtained 1 hour later from the orbitomeatal line to the mid thigh. Low dose CT images
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