title: A prospective evaluation of the utility of 2-deoxy-2-[(18) F]fluoro-D-glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer.
abstract: BACKGROUND
  The aim of this study was to examine prospectively the utility of adding preoperative [(18) F]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.
authors.affiliation: Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell Medical Center, New York, New York, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Smyth
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
authors.forename: Marinela
authors.initials: M
authors.lastname: Capanu
authors.forename: David P
authors.initials: DP
authors.lastname: Kelsen
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Manish A
authors.initials: MA
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D064847:Multimodal Imaging / Q000191:economics*; D061206:Neoplasm Micrometastasis / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D005791:Patient Care / Q000191:economics; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18