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 Journal Article
| Authors: | Smyth, E.; Schoder, H.; Strong, V. E.; Capanu, M.; Kelsen, D. P.; Coit, D. G.; Shah, M. A. |
| Article Title: | 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 |
| 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. © 2012 American Cancer Society. |
| Keywords: | positron emission tomography; laparoscopy; gastric cancer; tumor staging; economic model |
| Journal Title: | Cancer |
| Volume: | 118 |
| Issue: | 22 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2012-11-15 |
| Start Page: | 5481 |
| End Page: | 5488 |
| Language: | English |
| DOI: | 10.1002/cncr.27550 |
| PROVIDER: | scopus |
| PUBMED: | 22549558 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 3 December 2012" - "CODEN: CANCA" - "Source: Scopus" |
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