Improving patient selection for 18F-FDG PET scanning in the staging of gastric cancer.
Standard pretreatment staging for gastric cancer includes CT of the chest, abdomen, and pelvis; gastroscopy; and laparoscopy. Although (18)F-PET combined with CT has proven to be a useful staging tool in many cancers, some gastric cancers are not (18)F-FDG-avid and its clinical value is still debatable.


METHODS
Gastric cancer patients who underwent staging (18)F-FDG PET scans from 2002 to 2013 at the Peter MacCallum Cancer Center were retrospectively analyzed, and a systematic review was also conducted using PubMed between 2000 to March 2014 to investigate clinicopathologic parameters associated with (18)F-FDG avidity. A pretreatment PET scoring system was developed from predictors of (18)F-FDG avidity.


RESULTS
Both the retrospective analysis of the patients and the systematic literature review showed similar significant predictors of (18)F-FDG avidity, including large tumor size, non-signet ring cell carcinoma type, and glucose transporter 1-positive expression on immunohistochemistry. A PET scoring system was developed from these clinicopathologic parameters that allowed (18)F-FDG-avid tumors to be detected with a sensitivity of 85% and a specificity of 71%.


CONCLUSIONS
A pretreatment PET scoring system can assist in the selection of patients with gastric adenocarcinoma when staging (18)F-FDG PET is being considered.
Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Yui
Y
Kaneko
Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
William K
WK
Murray
Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; and.
Emma
E
Link
Department of Cancer imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Rodney J
RJ
Hicks
Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia cuong.duong@petermac.org.
Cuong
C
Duong
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D051272:Glucose Transporter Type 1 / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015588:Observer Variation; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*
D051272:Glucose Transporter Type 1; C495677:SLC2A1 protein, human; D019788:Fluorodeoxyglucose F18
FDG-PET; gastric cancer; staging