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 |
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| Authors: | Elizabeth Smyth MD Heiko Schöder MD Vivian E Strong MD Marinela Capanu PhD David P Kelsen MD Daniel G Coit MD Manish A Shah MD |
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| Institution: | 1. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan‐Kettering Cancer Center and Weill‐Cornell Medical Center, New York, New York;2. Department of Radiology, Nuclear Medicine, Memorial Sloan‐Kettering Cancer Center, New York, New York;3. Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan‐Kettering Cancer Center, New York, New York;4. Department of Epidemiology and Biostatistics, Memorial Sloan‐Kettering Cancer Center, New York, New York;5. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan‐Kettering Cancer Center and Weill‐Cornell Medical Center, New York, New YorkFax: (646) 962‐1607 |
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| 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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| Keywords: | gastric cancer positron emission tomography laparoscopy tumor staging economic model |
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