Performance of 18 F-FDG PET/CT as a postoperative surveillance imaging modality for asymptomatic advanced gastric cancer
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ORIGINAL ARTICLE
Performance of 18F-FDG PET/CT as a postoperative surveillance imaging modality for asymptomatic advanced gastric cancer patients Dong Yun Lee • Chang Hwan Lee Min Jung Seo • Suk Hyun Lee • Jin-Sook Ryu • Jong Jin Lee
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Received: 11 March 2014 / Accepted: 19 June 2014 / Published online: 26 June 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Objective The purpose of this study was to investigate the diagnostic performance of postoperative fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as a surveillance modality for advanced gastric cancer patients who were asymptomatic and negative by conventional follow-up. Methods We retrospectively collected 46 advanced gastric cancer patients who received approximately 1-yearpostoperative 18F-FDG PET/CT surveillance following curative resection (mean age 60.6 ± 11.5 years). 18F-FDG PET/CT was interpreted by nuclear medicine physicians who were blind to the clinical information. Final confirmation was determined by clinical follow-up using tumor markers, conventional CT scan, upper gastrointestinal endoscopy and with/without subsequent histopathologic diagnosis. Results Four patients developed recurrence (8.7 %; 1 local and 3 distant recurrences). For local recurrence,
D. Y. Lee M. J. Seo S. H. Lee J.-S. Ryu J. J. Lee (&) Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea e-mail: [email protected] D. Y. Lee Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea C. H. Lee Department of Surgery, Asan Medical Center,University of Ulsan College of Medicine, Seoul, Korea C. H. Lee Department of Gastrointestinal Cancer, Vievis Namuh Hospital, Seoul, Korea
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F-FDG PET/CT found four hypermetabolic lesions and one was local recurrence. For distant recurrence, seven hypermetabolic lesions were found in six patients and truepositive was three lesions. False-positive cases were mainly turned out to be physiologic small bowel uptake. Regardless of the recurrence site, the sensitivity, specificity, positive predictive value and negative predictive value of 18F-FDG PET/CT were 100 % (4/4, 95 % confidence interval (CI) 39.6–100 %), 88.1 % (37/42, 95 % CI 73.6–95.5 %), 44.4 % (4/9, 95 % CI 15.3–77.3 %) and 100 % (37/37, 95 % CI 88.3–100 %), respectively in the patient-based analysis. Conclusion Our study showed good specificity of postoperative surveillance 18F-FDG PET/CT for detecting recurrence. Careful caution should be made for interpreting some false-positive hypermetabolic lesions in postoperative 18F-FDG PET/CT, especially at the local anastomosis site. Keywords Advanced gastric cancer Asymptomatic 18 F-FDG PET/CT Surveillance Postoperative Recurrence
Introduction Stomach cancer is the fourth most common cancer worldwide [1] and demonstrates the third highest mortality rate in South Korea [2]. Death from gastric cancer is almost due to disease recurrence [3], and the recurrence rate of advanced gastri
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