Improving Patient Selection for 18F-FDG PET Scanning in the Staging of Gastric Cancer

1. Yui Kaneko1, 
2. William K Murray2, 
3. Emma Link3, 
4. Rodney J. Hicks4 and
5. Cuong Duong1

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Author Affiliations

1. 1Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
2. 2Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
3. 3Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; and
4. 4Department of Cancer imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

1. For correspondence or reprints contact: Cuong Duong, Department of Surgical Oncology, Peter MacCallum Cancer Centre, 7 St. Andrews Place, East Melbourne, VIC 3002, Australia. E-mail: cuong.duong@petermac.org

Abstract

Standard pretreatment staging for gastric cancer includes CT of the chest, abdomen, and pelvis; gastroscopy; and laparoscopy. Although 18F-PET combined with CT has proven to be a useful staging tool in many cancers, some gastric cancers are not 18F-FDG–avid and its clinical value is still debatable. Methods: Gastric cancer patients who underwent staging 18F-FDG PET scans from 2002 to 2013 at the Peter MacCallum Cancer Center were retrospectively analyzed, and a systematic review was also conducted using PubMed between 2000 to March 2014 to investigate clinicopathologic parameters associated with 18F-FDG avidity. A pretreatment PET scoring system was developed from predictors of 18F-FDG avidity. Results: Both the retrospective analysis of the patients and the systematic literature review showed similar significant predictors of 18F-FDG avidity, including large tumor size, non–signet ring cell carcinoma type, and glucose transporter 1–positive expression on immunohistochemistry. A PET scoring system was developed from these clinicopathologic parameters that allowed 18F-FDG–avid tumors to be detected with a sensitivity of 85% and a specificity of 71%. Conclusion: A pretreatment PET scoring system can assist in the selection of patients with gastric adenocarcinoma when staging 18F-FDG PET is being considered.

Keywords

• FDG-PET
 
• gastric cancer
 
• staging

Footnotes

• Published online Mar. 5, 2015.

• © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Link original: http://jnm.snmjournals.org/content/56/4/523