A prospective evaluation of the utility of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer

Authors

  • Elizabeth Smyth MD,

    1. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell Medical Center, New York, New York
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  • Heiko Schöder MD,

    1. Department of Radiology, Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Vivian E. Strong MD,

    1. Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Marinela Capanu PhD,

    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • David P. Kelsen MD,

    1. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell Medical Center, New York, New York
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  • Daniel G. Coit MD,

    1. Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Manish A. Shah MD

    Corresponding author
    1. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell Medical Center, New York, New York
    • Associate Professor of Medicine, Director of Gastrointestinal Oncology, Weill Cornell Medical College, 1305 York Avenue, 12th Floor, New York, NY 10021
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    • Fax: (646) 962-1607


  • Presented in part at the 2008 American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 25-27, 2008; Orlando, Florida.

Abstract

BACKGROUND:

The aim of this study was to examine prospectively the utility of adding preoperative [18F]fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) to routine CT, endoscopic ultrasound (EUS), and laparoscopic staging of localized gastric cancer.

METHODS:

Patients with locally advanced gastric/gastroesophageal cancer were screened for 2 institutional review board–approved Memorial Sloan-Kettering Cancer Center neoadjuvant chemotherapy protocols. Locally advanced disease was defined as T3 or T4, or lymph node–positive, based on EUS and high-resolution CT scan. All patients underwent both standard FDG-PET/CT and laparoscopy with cytological examination of washings. The sensitivity and specificity of FDG-PET/CT for the identification of metastatic disease not seen on CT was determined. An economic model using Medicare/Medicaid reimbursement charges was developed to assess the cost-effectiveness of these interventions.

RESULTS:

A total of 113 patients were enrolled from 2003 to 2010. All patients were assessed as having locally advanced disease by CT/EUS. FDG uptake in the primary tumor was associated with male sex, proximal tumors, and nondiffuse Lauren's subtype. 31 (27%) patients had occult metastatic disease detected by PET/CT (n = 11, 10%) and/or laparoscopy (n = 21, 19%), with a single overlap. Economic modeling suggests that the addition of FDG-PET/CT to the standard staging evaluation of patients with locally advanced gastric cancer resulted in an estimated cost savings of ∼US $13,000 per patient.

CONCLUSIONS:

FDG-PET/CT identifies occult metastatic lesions in approximately 10% of patients with locally advanced gastric cancer. Because of reduced morbidity from fewer futile surgeries and lower patient care costs, PET/CT should be considered as a component of the standard staging algorithm for localized gastric cancer. Cancer 2012. © 2012 American Cancer Society.

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