Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterological Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Ann Surg Oncol. 2018 Jun;25(6):1633-1639. doi: 10.1245/s10434-018-6455-0. Epub 2018 Apr 6.
Preoperative precise staging is essential for the treatment of gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be increased. The present study investigated the clinical value of positron emission tomography-computed tomography (PET-CT) for the staging of GC.
This was a retrospective study of 117 patients with a clinical diagnosis of advanced GC who underwent PET-CT followed by gastrectomy. The incidence of FDG uptake in the primary tumor or lymph nodes and its relationship with clinicopathological factors, particularly pathological stage (pStage) III/IV, were examined.
FDG uptake in the primary tumor was noted in 83 patients (70.9%). FDG uptake in the lymph nodes was detected in 21 patients (17.9%), and its sensitivity and specificity for lymph node metastasis were 22.7 and 90.5%, respectively. Multiple logistic regression analyses showed that FDG uptake in the primary tumor (odds ratio (OR) 2.764; 95% confidence interval (CI) 1.104-7.459, p = 0.029) and that in the lymph nodes (OR 4.660; 95% CI 1.675-13.84, p = 0.003) were factors independently associated with pStage III/IV. FDG uptake in the primary tumor detected pStage III/IV with higher sensitivity (80.4%) and that in lymph nodes found pStage III/IV with higher specificity (88.7%) than those of upper endoscopy plus CT (60.9 and 67.6%, respectively).
PET-CT appears to be a useful complementary modality in the assessment of pStage III/IV because of the high sensitivity of FDG uptake in the primary tumor and the high specificity of FDG uptake in the lymph nodes.
术前准确分期对于胃癌（GC）的治疗至关重要；然而，需要提高常规方式的诊断准确性。本研究探讨了正电子发射断层扫描-计算机断层扫描（PET-CT）在 GC 分期中的临床价值。
这是一项回顾性研究，共纳入 117 例临床诊断为晚期 GC 并接受 PET-CT 检查后行胃切除术的患者。检查了原发肿瘤或淋巴结中 FDG 摄取的发生率及其与临床病理因素（特别是病理分期 [pStage] III/IV）的关系。
83 例患者（70.9%）的原发肿瘤存在 FDG 摄取。21 例患者（17.9%）检测到淋巴结 FDG 摄取，其对淋巴结转移的敏感性和特异性分别为 22.7%和 90.5%。多因素逻辑回归分析显示，原发肿瘤 FDG 摄取（比值比 [OR] 2.764；95%置信区间 [CI] 1.104-7.459，p=0.029）和淋巴结 FDG 摄取（OR 4.660；95% CI 1.675-13.84，p=0.003）是与 pStage III/IV 相关的独立因素。原发肿瘤 FDG 摄取检测 pStage III/IV 的敏感性（80.4%）高于上消化道内镜加 CT（60.9%），而淋巴结 FDG 摄取检测 pStage III/IV 的特异性（88.7%）高于上消化道内镜加 CT（67.6%）。
由于原发肿瘤 FDG 摄取的高敏感性和淋巴结 FDG 摄取的高特异性，PET-CT 似乎是评估 pStage III/IV 的有用补充方式。
