title: Added value of pretreatment (18)F-FDG PET/CT for staging of advanced gastric cancer: Comparison with contrast-enhanced MDCT.
abstract: OBJECTIVE
  To evaluate the added clinical value of pretreatment (18)F-FDG PET/CT compared with conventional contrast-enhanced multidetector-row CT (CECT) alone for staging of advanced gastric cancer
  
  
  METHODS
  We studied 106 patients with locally advanced gastric cancer who underwent pretreatment CECT and (18)F-FDG PET/CT. Two experienced reviewers assessed the diagnostic performance of both CECT alone and the combination of CECT and (18)F-FDG PET/CT for the primary tumor, regional lymph node metastasis (N) and distant metastasis (M), rating their diagnostic confidence with a 5-point scoring system for each location. The two methods were compared using receiver operating characteristic (ROC) curve analysis for histopathologic findings, imaging, and clinical follow-up as the reference standards.
  
  
  RESULTS
  Among the 106 patients, 96 primary tumors (90.6%) were detected by CECT, while 101 (95.3%) were clearly identified by (18)F-FDG PET/CT (p=0.074). Patient-based areas under the ROC curves for CECT alone versus the combination of CECT and (18)F-FDG PET/CT for diagnosis of N stage, peritoneal dissemination, liver metastasis, distant lymph node metastasis, bone metastasis, metastasis at other sites and overall M stage were 0.787 vs. 0.858 (p=0.13), 0.866 vs. 0.878 (p=0.31), 0.998 vs. 1.0 (p=0.36), 0.744 vs. 0.865 (p=0.049), 0.786 vs. 0.998 (p=0.034), 0.944 vs. 0.984 (p=0.34), and 0.889 vs. 0.912 (p=0.21), respectively. The diagnostic performance of primary tumor detection and NM staging was not influenced by the histologic subtype.
  
  
  CONCLUSIONS
  Adding (18)F-FDG PET/CT to CECT provides better diagnostic accuracy for detection of distant lymph node metastasis and bone metastasis in patients with untreated advanced gastric cancer.
authors.affiliation: Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: n_you_634@yahoo.co.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawanaka
authors.affiliation: Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: kazu10041976@yahoo.co.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kitajima
authors.affiliation: Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: fukuchan0106@gmail.com.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, Japan. Electronic address: m-mou@hyo-med.ac.jp.
authors.forename: Miya
authors.initials: M
authors.lastname: Mouri
authors.affiliation: Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: h-doi@hyo-med.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Doi
authors.affiliation: Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: tsutomu@hyo-med.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: hironiwa@hyo-med.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Niwa
authors.affiliation: Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: kaibe-2s@hyo-med.ac.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kaibe
authors.affiliation: Division of Upper G.I. Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: msasako@hyo-med.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
authors.affiliation: Division of Gastroenterology, Department of Internal medicine, Hyogo College of Medicine, Japan. Electronic address: tomita@hyo-med.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tomita
authors.affiliation: Division of Gastroenterology, Department of Internal medicine, Hyogo College of Medicine, Japan. Electronic address: miwahgi@hyo-med.ac.jp.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.affiliation: Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: hirota-s@hyo-med.ac.jp.
authors.forename: Shozo
authors.initials: S
authors.lastname: Hirota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG; Gastric cancer; PET/CT; Staging