Abstract
Purpose
We evaluated the value of fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) as a complementary imaging modality to endoscopy to predict the curability of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).
Methods
The institutional review board approved this retrospective study with a waiver of informed consent. The records of patients who underwent FDG PET/CT for initial routine staging of gastric cancer from January 2012 to October 2017 were reviewed retrospectively. Among them, the patients who had EGC with well or moderately differentiated adenocarcinoma were included in this study. A total of 210 EGCs in 199 patients (mean age ± SD, 67 ± 10 years) were selected for this study. For the analysis of FDG PET/CT image, the radiotracer uptake by the primary tumor was compared with the background gastric uptake. Each case was classified as curable by ESD (no discrete radioactivity) and not curable by ESD (discrete radioactivity).
Results
The detection rate of EGC by FDG PET/CT was 37.1% (78 discrete radioactivity in 210 EGCs). However, for the detection of EGC that is not curable by ESD, the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve with 95% confidence intervals were 79% (67–87%), 91% (85–95%), 81% (71–88%), 89% (84–93%), and 0.85 (0.79–0.89), respectively.
Conclusion
FDG PET/CT may be a useful complementary imaging modality to endoscopy to predict the curability of ESD for EGC.
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References
Abe S, Oda I, Shimazu T, Kinjo T, Tada K, Sakamoto T et al (2011) Depth-predicting score for differentiated early gastric cancer. Gastric Cancer 14(1):35–40. https://doi.org/10.1007/s10120-011-0002-z
Cardoso R, Coburn NG, Seevaratnam R, Mahar A, Helyer L, Law C et al (2012) A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review. Gastric Cancer 15(Suppl 1):S164–S167. https://doi.org/10.1007/s10120-012-0142-9
Chung HW, Lee EJ, Cho YH, Yoon SY, So Y, Kim SY et al (2010) High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma. J Cancer Res Clin Oncol 136(12):1929–1935. https://doi.org/10.1007/s00432-010-0852-5
Chung HW, Lee KY, Kim HJ, Kim WS, So Y (2014) FDG PET/CT metabolic tumor volume and total lesion glycolysis predict prognosis in patients with advanced lung adenocarcinoma. J Cancer Res Clin Oncol 140(1):89–98. https://doi.org/10.1007/s00432-013-1545-7
Coupe NA, Karikios D, Chong S, Yap J, Ng W, Merrett N et al (2014) Metabolic information on staging FDG-PET-CT as a prognostic tool in the evaluation of 97 patients with gastric cancer. Ann Nucl Med 28(2):128–135. https://doi.org/10.1007/s12149-013-0791-8
Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10(1):1–11. https://doi.org/10.1007/s10120-006-0408-1
Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ et al (2013) EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med 54(4):647–658. https://doi.org/10.2967/jnumed.112.112524
Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ et al (2014) Clinical practice guidelines for gastric cancer in korea: an evidence-based approach. J Gastric Cancer 14(2):87–104. https://doi.org/10.5230/jgc.2014.14.2.87
Lee EJ, Chang SH, Lee TY, Yoon SY, Cheon YK, Shim CS et al (2015) Prognostic value of FDG-PET/CT total lesion glycolysis for patients with resectable distal bile duct adenocarcinoma. Anticancer Res 35(12):6985–6991
Lee Y, Yoo IR, Boo SH, Kim H, Park HL, Hyun OJ (2017) The role of F-18 FDG PET/CT in intrahepatic cholangiocarcinoma. Nucl Med Mol Imaging 51(1):69–78. https://doi.org/10.1007/s13139-016-0440-y
Margulies C, Krevsky B, Catalano MF (1994) How accurate are endoscopic estimates of size? Gastrointest Endosc 40(2 Pt 1):174–177
Mouri R, Yoshida S, Tanaka S, Oka S, Yoshihara M, Chayama K (2009) Usefulness of endoscopic ultrasonography in determining the depth of invasion and indication for endoscopic treatment of early gastric cancer. J Clin Gastroenterol 43(4):318–322. https://doi.org/10.1097/MCG.0b013e3181775966
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48(2):225–229
Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N et al (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28(1):3–15. https://doi.org/10.1111/den.12518
Park S, Ha S, Kwon HW, Kim WH, Kim TY, Oh DY et al (2017) Prospective evaluation of changes in tumor size and tumor metabolism in patients with advanced gastric cancer undergoing chemotherapy: association and clinical implication. J Nucl Med 58(6):899–904. https://doi.org/10.2967/jnumed.116.182675
Pasechnikov V, Chukov S, Fedorov E, Kikuste I, Leja M (2014) Gastric cancer: prevention, screening and early diagnosis. World J Gastroenterol 20(38):13842–13862. https://doi.org/10.3748/wjg.v20.i38.13842
Ryu DG, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ et al (2017a) Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy. Gastric Cancer 20(4):671–678. https://doi.org/10.1007/s10120-016-0665-6
Ryu DG, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ et al (2017b) Predictive factors to diagnosis undifferentiated early gastric cancer after endoscopic submucosal dissection. Medicine (Baltimore) 96(36):e8044. https://doi.org/10.1097/MD.0000000000008044
Shoda H, Kakugawa Y, Saito D, Kozu T, Terauchi T, Daisaki H et al (2007) Evaluation of 18F-2-deoxy-2-fluoro-glucose positron emission tomography for gastric cancer screening in asymptomatic individuals undergoing endoscopy. Br J Cancer 97(11):1493–1498
Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah MA et al (2013) Comparison of disease-specific survival in the united states and korea after resection for early-stage node-negative gastric carcinoma. J Surg Oncol 107(6):634–640. https://doi.org/10.1002/jso.23288
Tanaka S, Toyonaga T, Morita Y, Ishida T, Hoshi N, Grimes KL et al (2017) Efficacy of a new hemostatic forceps during gastric endoscopic submucosal dissection: a prospective randomized controlled trial. J Gastroenterol Hepatol 32(4):846–851. https://doi.org/10.1111/jgh.13599
Uedo N, Fujishiro M, Goda K, Hirasawa D, Kawahara Y, Lee JH et al (2011) Role of narrow band imaging for diagnosis of early-stage esophagogastric cancer: current consensus of experienced endoscopists in asia-pacific region. Dig Endosc 23(Suppl 1):58–71. https://doi.org/10.1111/j.1443-1661.2011.01119.x
Vakil N, Smith W, Bourgeois K, Everbach EC, Knyrim K (1994) Endoscopic measurement of lesion size: Improved accuracy with image processing. Gastrointest Endosc 40(2 Pt 1):178–183
Yao K, Yao T, Matsui T, Iwashita A, Oishi T (2000) Hemoglobin content in intramucosal gastric carcinoma as a marker of histologic differentiation: a clinical application of quantitative electronic endoscopy. Gastrointest Endosc 52(2):241–245
Yao K, Oishi T, Matsui T, Yao T, Iwashita A (2002a) Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 56(2):279–284
Yao K, Matsui T, Furukawa H, Yao T, Sakurai T, Mitsuyasu T (2002b) A new stereoscopic endoscopy system: accurate 3-dimensional measurement in vitro and in vivo with distortion-correction function. Gastrointest Endosc 55(3):412–420. https://doi.org/10.1067/mge.2002.121598
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This study was reviewed by the appropriate Ethics Committee and was, therefore, performed in accordance with the ethical standards laid down in the Declaration of Helsinki revised in Brazil 2013.
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This retrospective study was waived from the need to obtain informed consent by our Institutional Review Board (KUH1280106).
Conflict of interest
Hyun Woo Chung, Jeong Hwan Kim, In-Kyung Sung, Sun-Young Lee, Hyung Seok Park, Chan Sup Shim, Ho Yoon Bang, Young So, and Eun Jeong Lee declare that they have no conflicts of interest.
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This work described has not been published before and it is not under consideration for publication anywhere else. Its publication has been approved by all co-authors.
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Chung, H.W., Kim, J.H., Sung, IK. et al. FDG PET/CT to predict the curability of endoscopic resection for early gastric cancer. J Cancer Res Clin Oncol 145, 759–764 (2019). https://doi.org/10.1007/s00432-018-02832-9
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DOI: https://doi.org/10.1007/s00432-018-02832-9