Abstract
There have been no comparative studies investigating the results of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients with gastric mesenchymal tumors, including leiomyomas, leiomyosarcomas, schwannomas, and gastrointestinal stromal tumors (GISTs). We retrospectively reviewed the data of 142 patients with pathologically diagnosed gastric mesenchymal tumors treated at 11 institutions. We analyzed the correlation between the maximum standardized uptake value (SUVmax) evaluated using fluorodeoxyglucose-positron emission tomography (FDG-PET) and the tumor size. The correlation between the SUVmax and mitotic index was also investigated in GISTs. The SUVmax (mean ± standard deviation) was 0.5 ± 0.6 in very low-risk GISTs (n = 42), 2.1 ± 0.7 in low-risk GISTs (n = 26), 4.9 ± 0.8 in intermediate-risk GISTs (n = 22), 12.3 ± 0.8 in high-risk GISTs (n = 20), 1.0 ± 1.0 in leiomyomas (n = 15), 6.9 ± 1.2 in schwannomas (n = 10), and 3.5 in a leiomyosarcoma (n = 1). The SUVmax of GISTs with an undetermined risk classification was 4.2 ± 1.3 (n = 8). Linear associations were observed between the SUVmax and tumor size in GISTs, leiomyomas, and schwannomas. The SUVmax of GISTs with a high mitotic index was significantly higher than that of GISTs with a low mitotic index (9.6 ± 7.6 vs. 2.4 ± 4.2). In conclusion, we observed positive correlations between the SUVmax and tumor size in GISTs, leiomyomas, and schwannomas. The SUVmax also positively correlated with the mitotic index and risk grade in GISTs. Schwannomas showed a higher FDG uptake than GISTs and leiomyomas.
Highlights
Gastric mesenchymal tumors include leiomyomas, leiomyosarcomas, schwannomas, and gastrointestinal stromal tumors (GISTs) [1]
The risk of GISTs was not categorized in five patients because the mitotic index was not evaluated, owing to the small sample size from endoscopic ultrasound-guided fine-needle aspiration biopsy
Mixed results have been noted with respect to tumor size, in that several reports failed to show a correlation between FDG avidity and
Summary
Gastric mesenchymal tumors include leiomyomas, leiomyosarcomas, schwannomas, and gastrointestinal stromal tumors (GISTs) [1]. Uptake of FDG by the tumor is considered to reflect cellular proliferation, and is used as a marker for determining the malignant potential of various neoplasms. Previous studies have demonstrated that the FDG uptake has a significant correlation with the malignant potential of gastric GISTs [2,3]. There have been previous cases of gastric schwannomas misdiagnosed as malignant GISTs based on fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging findings [4]. The FDG-PET results and clinical characteristics of 142 patients with gastric mesenchymal tumors, including 118 GISTs, 15 leiomyomas, 10 schwannomas, and 1 leiomyosarcoma, were retrospectively examined. The aim of the current study was to investigate the role of FDG-PET and the findings that need cautious interpretation in the preoperative diagnosis of gastric mesenchymal tumors
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