Abstract
BackgroundGastric carcinoma and primary gastric lymphoma (PGL) are the two most common malignancies in stomach. The purpose of this study was to screen and validate a biomarker of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for distinguishing advanced gastric carcinoma (AGC) from PGL for clinical applications.Methodology/Principal FindingsWe reviewed PET/CT scans collected from January 2008 to April 2012 of 69 AGC and 38 PGL (14 low-grade mucosa-associated lymphoid tissue [MALT], 24 non-MALT aggressive non-Hodgkin lymphoma [ANHL]) with a focus on FDG intensity (maximum standardized uptake value [SUVmax]) of primary lesions and its CT-detected abnormalities, including maximal gastrointestinal wall thickness (THKmax) and mucosal ulcerations. Gastric FDG uptake was found in 69 (100%) patients with AGC and 36 (95%, 12 MALT vs. 24 ANHL)with PGL. The presence of CT-detected abnormalities of AGC and PGL were 97% (67/69) and 89% (12 MALT vs. 22 ANHL), respectively. After controlling for THKmax, SUVmax was higher with ANHL than AGC (17.10±8.08 vs. 9.65±5.24, p<0.05) and MALT (6.20±3.60, p<0.05). THKmax did not differ among MALT, ANHL and AGC. Mucosal ulceration was more common with AGC (n = 9) than PGL (n = 2),but the difference was not statistically significant (p>0.05). Cross-validation analysis showed that for distinguishing ANHL from AGC, the classifier with SUVmax as a feature achieved a correct classification rate of 81% with thresholds 13.40±1.12 and the classifier with SUVmax/THKmax as a feature achieved a correct classification rate of 83% with thresholds 7.51±0.63.Conclusions/SignificanceSUVmax/THKmax may be as a promising biomarker of FDG-PET/CT for distinguishing ANHL from AGC. Structural CT abnormalities alone may not be reliable but can help with PET assessment of gastric malignancies. 18F-FDG PET/CT have potential for distinguishing AGC from PGL at the individual level.
Highlights
Gastric carcinoma (GC) and primary gastric lymphoma (PGL) are the 2 most commonly encountered malignant entities in the stomach
Participants We reviewed 107 consecutive patients suffering from PGL and advanced gastric carcinoma (AGC) from January 2008 to April 2012
ANOVA revealed that SUVmax was higher in patients with ANHL than MALT and AGC (F = 18.34, p,0.001); ANCOVA revealed the similar trend (F = 4.22 p = 0.036)
Summary
Gastric carcinoma (GC) and primary gastric lymphoma (PGL) are the 2 most commonly encountered malignant entities in the stomach. Primary gastric non-Hodgkin’s lymphoma accounts for less than 15% of gastric malignancies and 2% of lymphomas, and the stomach is the most common site of extra-nodal involvement in non-Hodgkin’s lymphoma [3,4]. There has been a debate on the best therapeutic strategy for PGL, it has been generally believed that for localized lesion(s) in the early stages (stage I E & II E), surgery is adequate and of clinical benefit. Gastric carcinoma and primary gastric lymphoma (PGL) are the two most common malignancies in stomach. The purpose of this study was to screen and validate a biomarker of 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) for distinguishing advanced gastric carcinoma (AGC) from PGL for clinical applications
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