Abstract
Aim18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is valuable in the management of patients with oesophageal cancer, but a role in gastric cancer staging is debated. Our aim was to review the role of FDG PET-CT in a large gastric cancer cohort in a tertiary UK centre.MethodsWe retrospectively reviewed data from 330 patients presenting with gastric adenocarcinoma between March 2014 and December 2016 of whom 105 underwent pre-treatment staging FDG PET-CT scans. FDG PET-CT scans were graded qualitatively and quantitatively (SUVmax) and compared with staging diagnostic CT and operative pathology results (n = 30) in those undergoing resection.ResultsOf the 105 patients (74 M, median age 73 years) 86% of primary tumours were metabolically active (uptake greater than normal stomach) on FDG PET-CT [41/44 (93%) of the intestinal histological subtype (SUVmax 14.1 ± 1.3) compared to 36/46 (78%) of non-intestinal types (SUVmax 9.0 ± 0.9), p = 0.005]. FDG PET-CT upstaged nodal or metastastic staging of 20 patients (19%; 13 intestinal, 6 non-intestinal, 1 not reported), with 17 showing distant metastases not evident on other imaging. On histological analysis, available in 30 patients, FDG PET-CT showed low sensitivity (40%) but higher specificity (73%) for nodal involvement.ConclusionFDG PET-CT provides new information in a clinically useful proportion of patients, which leads to changes in treatment strategy, most frequently by detecting previously unidentified metastases, particularly in those with intestinal-type tumours.
Highlights
Gastric adenocarcinoma can have a poor prognosis, especially in Western countries where presentation is often at a moreThis article is part of the Topical Collection on Oncology – Digestive tract advanced stage at the time of diagnosis [1]
In the present retrospective study, we aimed to investigate the usefulness of Positron emission tomography (PET)-computed tomography (CT) in the staging work-up of patients with gastric adenocarcinoma and whether this has an impact on subsequent management
The average size of FDG negative tumours was 39.7 mm, i.e. tumours were larger than the resolution of PET-CT
Summary
This article is part of the Topical Collection on Oncology – Digestive tract advanced stage at the time of diagnosis [1]. Those with early tumours, with no or limited nodal involvement, may have surgical resection combined with either neoadjuvant or adjuvant chemotherapy, whereas patients with metastases (M1) are typically managed by palliative means, including chemotherapy and best supportive care without resection. A further consideration is the potential morbidity and mortality from gastric surgery [3], mandating accurate selection of patients who will benefit from surgery and are not harbouring undetected metastatic disease, which may render surgical intervention futile. Staging of gastric cancer is typically based on endoscopic biopsy, computed tomography (CT) and laparoscopy for those deemed to have loco-regional disease.
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