Chen Jian, Cheong Jae-Ho, Yun Mi Jin, Kim Junuk, Lim Joon Seok, Hyung Woo Jin, Noh Sung Hoon
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Cancer. 2005 Jun 1;103(11):2383-90. doi: 10.1002/cncr.21074.
Positron emission tomography (PET) with 18- fluorodeoxyglucose (FDG) has been used to both detect and stage a variety of malignancies. The current study examined the value of PET for preoperative staging of gastric adenocarcinoma.
Sixty-eight patients (49 males and 19 females) with gastric adenocarcinoma, who were referred for preoperative FDG-PET scans, were enrolled in this study. The patients underwent spiral-computed tomography (CT) within 1 week of referral. The final diagnosis in all patients was made by histologic and surgical findings. For quantitative PET analysis, the regional tumor FDG uptake was measured by the standardized uptake value (SUV).
For the primary tumor of a gastric adenocarcinoma, PET demonstrated an increased uptake in 64 of 68 patients (sensitivity, 94%), with a mean SUV of 7.0 (range, 0.9-27.7). A comparison of FDG uptake and clinicopathologic features showed significant association between FDG uptake and macroscopic type, tumor size, lymph node metastasis, histologic type, and TNM stage. The PET scan had a similar accuracy with that of CT for diagnosing local and distant lymph node metastases as well as peritoneal status. In assessing local lymph node status, however, PET had a higher specificity than CT (92% vs. 62%, P = 0.000). Moreover, PET had additional diagnostic value in 10 (15%) of 68 patients by upstaging 4 (6%) and downstaging 6 (9%) patients. PET combined with CT was more accurate for preoperative staging than either modality alone (66% vs. 51%, 66% vs. 47%, respectively; P = 0.002).
FDG-PET improves the preoperative TNM staging of gastric adenocarcinoma. Based on its superior specificity, FDG-PET can facilitate the selection of patients for a curative resection by confirming a nodal status identified by CT.
正电子发射断层扫描（PET）联合18-氟脱氧葡萄糖（FDG）已用于多种恶性肿瘤的检测和分期。本研究探讨了PET在胃腺癌术前分期中的价值。
本研究纳入了68例因胃腺癌接受术前FDG-PET扫描的患者（49例男性，19例女性）。患者在转诊后1周内接受螺旋计算机断层扫描（CT）。所有患者的最终诊断均依据组织学和手术结果。对于PET定量分析，通过标准化摄取值（SUV）测量肿瘤区域的FDG摄取情况。
对于胃腺癌的原发肿瘤，PET显示68例患者中有64例摄取增加（敏感性为94%），平均SUV为7.0（范围为0.9-27.7）。FDG摄取与临床病理特征的比较显示，FDG摄取与大体类型、肿瘤大小、淋巴结转移、组织学类型和TNM分期之间存在显著关联。PET扫描在诊断局部和远处淋巴结转移以及腹膜状况方面与CT具有相似的准确性。然而，在评估局部淋巴结状况时，PET的特异性高于CT（92%对62%，P = 0.000）。此外，PET在68例患者中有10例（15%）具有额外的诊断价值，其中4例（6%）分期上调，6例（9%）分期下调。PET联合CT在术前分期方面比单独使用任何一种方法都更准确（分别为66%对51%，66%对47%；P = 0.002）。
FDG-PET可改善胃腺癌的术前TNM分期。基于其更高的特异性，FDG-PET可通过确认CT所确定的淋巴结状况，有助于选择适合进行根治性切除的患者。
