Abstract
We aimed to investigate the relationship between the use of fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT), maximized standardized uptake value (SUVmax) values of tumors, and tumor differentiation and tumor markers during the initial staging of patients with gastric cancer. The study included 50 patients (14 women and 36 men; mean age: 63±11 years; age range: 31-80 years) who had undergone initial staging with FDG-PET/CT after the diagnosis of gastric cancer with endoscopic biopsy between January and June 2013. Serum alpha fetoprotein (AFP), carcinogenic antigen 19-9 (CA 19.9), carcinoembryonic antigen (CEA), and C-reactive protein (CRP) levels were measured in patients prior to imaging. PET/CT images were evaluated for primary tumors, locoregional spread, and distant organ metastases, and classified by tumor-node-metastasis staging. Semiquantitative data were collected by SUVmax measurements in pathological regions of involvement. Data were analyzed statistically. FDG-PET/CT showed primary gastric cancer with a sensitivity of 87%. Imaging findings were normal in 3 patients (1/3; mucinous adenocarcinoma, 2/3; signet-ring cell adenocarcinoma). With FDG-PET/CT, 3/50 patients were classified into Stage 1B, 3/50 patients into Stage 2, 5/50 patients into Stage 3A, 5/50 patients into Stage 3B, 5/50 patients into 3C and 29/50 patients into Stage 4. The mean SUVmax was calculated as 11.35±4.3 (poorly differentiated adenocarcinoma: 5.4±1.7; moderately differentiated adenocarcinoma: 10.3±4.8) for the primary tumor and 14.9±6.3 for tumor metastasis. A positive correlation was evident between the measured SUVmax and stage and the grade of primary tumor (p<0.05). While the relationship between SUVmax and levels of serum AFP and CRP was statistically significant (p<0.05), the relationship between SUVmax and levels of serum CA 19-9 and CEA was not statistically significant (p>0.05). The SUVmax of primary tumors was associated with the degree of differentiation of primary tumors and the biochemical tumor markers CRP and AFP. The fact that SUVmax of primary tumors is high supplies clues about the presence of the factors affecting prognosis of the disease.
Highlights
Gastric cancer is the world’s third-leading cause of cancer-related deaths in men after lung cancer, and the second-most common cause in women after breast cancer [1]
The mean SUVmax was calculated as 11.35±4.3 for the primary tumor and 14.9±6.3 for tumor metastasis
The SUVmax of primary tumors was associated with the degree of differentiation of primary tumors and the biochemical tumor markers C-reactive protein (CRP) and alpha fetoprotein (AFP)
Summary
Gastric cancer is the world’s third-leading cause of cancer-related deaths in men after lung cancer, and the second-most common cause in women after breast cancer [1]. It is difficult to make an early diagnosis of gastric cancer because it frequently manifests in the form of weight loss and anemia [2]. The gold standard method for the diagnosis of gastric cancer is still endoscopy and biopsy. Positron emission tomography (PET) is a molecular imaging method that provides physiological information required for clinical diagnosis based on changes in tissue metabolism. Many malignant tumors can be noninvasively visualized through PET using fluoro-2-deoxyglucose (FDG) labeled with fluorine-18 due to increased glucose metabolism [4]. FDG-PET/CT is an imaging modality in which CT can compensate for the limited spatial resolution of PET, and anatomical and morphological information is completed with metabolic and molecular information and
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