The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer

aksel, bulent; KİR, Kemal Metin; İBİŞ, Erkan; Ozkan, Elgin; Soydal, Cigdem; KÜÇÜK, NURİYE ÖZLEM; AKGÜL, Hikmet; FILIK, MUSTAFA

The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer

Mustafa FİLİK, (Dr. A. İlhan Özdemir Devlet Hastanesi, Nükleer Tıp Kliniği, Giresun, Türkiye)

Kemal Metin KİR, (Ankara Üniversitesi, Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, Ankara, Türkiye)

Bülent AKSEL, (Ankara Üniversitesi, Tıp Fakültesi, Onkoloji Anabilim Dalı, Ankara, Türkiye)

Çiğdem SOYDAL, (Ankara Üniversitesi, Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, Ankara, Türkiye)

Elgin ÖZKAN, (Ankara Üniversitesi, Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, Ankara, Türkiye)

NURİYE ÖZLEM KÜÇÜK, (Ankara Üniversitesi, Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, Ankara, Türkiye)

Erkan İBİŞ, (Ankara Üniversitesi, Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, Ankara, Türkiye)

Hikmet AKGÜL (Ankara Üniversitesi, Tıp Fakültesi, Onkoloji Anabilim Dalı, Ankara, Türkiye)

Molecular Imaging and Radionuclide Therapy

4 0

Yıl: 2015 Cilt: 24 Sayı: 1 Sayfa Aralığı: 15 - 20 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer

Öz:

Amaç: Bu çalışmada amaç, endoskopik biyopsi ile mide kanseri tanısı alan hastaların cerrahi öncesi evrelemesinde 18F-FDG PET-BTnin rolünün araştırılması, evrelemede rutinde kullanılan BT ile karşılaştırılması ve 18F-FDG tutulumunu etkileyen parametrelerin değerlendirilmesidir. Yöntem: Çalışmaya Haziran 2011-Haziran 2012 tarihleri arasında histopatolojik olarak kanıtlanmış mide kanseri tanısı olan ve tedavi öncesi evreleme amacı ile 18F-FDG PET/BT yapılan 31 hasta (ortalama yaş 58,9±12,6) dahil edildi. 18F-FDG PET/BT sonrası operasyon uygulanan hastalarda PET/BT bulguları hastaların PET/BT sonrası yapılan operasyonlarına ait patoloji raporları ile karşılaştırıldı. Primer lezyon, lenf nodları ve komşu organlara ait 18F-FDG PET/BT ve BT bulguları patoloji sonuçları ile karşılaştırıldı. Altı hastada ise 18F-FDG PET/BT ve BT bulguları ya da laparotomi ve/veya laparoskopi ile inoperabilite kararı verildiğinden primer lezyon ve lenf nodlarına ait verilerin patoloji sonuçları ile karşılaştırması yapılamadı. Bulgular: Hastalar postoperatif histopatoloji sonuçları ile TNM evrelemesine göre değerlendirildiğinde, 1 hasta T0 (%4), 1 hasta Tis (%4), 4 hasta T1 (%16), 2 hasta T2 (%8), 12 hasta T3 (%48), 5 hasta T4 (%20) olarak saptandı. Cerrahi sonrası N evresine göre ise 8 hasta N0 (%32), 6 hasta N1 (%24), 6 hasta N2 (%24), 5 hasta N3 (%20) olarak kabul edildi. 18F-FDG PET/ BT, 2/31 hastada normal, 27/31 hastada midede primer tümörde, 17/31 hastada perigastrik lenf nodlarında, 6/31 hastada uzak organda patolojik 18F-FDG tutulumu olarak raporlandı. Midede primer lezyonda 18F-FDG tutulumu izlenen hastaların ortalama SUVmax değeri 13,49±9,29 (3,00-44,60) olarak hesaplanırken, lenf nodunda aktivite tutulumu izlenen hastaların ortalama SUVmax değeri 9,28±6,92 (2,80-29,10) olarak hesaplandı. Hastaların histopatolojik tanılarına göre primer tümörde 18F-FDG tutulumu incelendiğinde, ortalama SUVmax, adenokarsinomda 15,16 (3,00-44,60), taşlı yüzük hücreli karsinomda 9,90 (5,50-17,70), taşlı yüzük hücre komponenti bulunduran adenokarsinomda 11,27 (6,20-13,90) olarak hesaplandı (p=0,721). BT sonuçlarının postoperatif histopatoloji sonuçları ile karşılaştırıldığında, primer lezyonun saptanmasında BT 23/25 hastada GP, 1/25 hastada GN, 1/25 hastada ise YN olarak değerlendirildi. 18F-FDG PET/BT ise, 20/25 hasta GP, 1/25 hasta YP, 4/25 hasta YN olarak değerlendirildi. BTnin lenf nodu metastazını saptamada duyarlılık, özgüllük, doğruluğu, PPD ve NPDsi sırasıyla, %83,3, %75, %80, %87,5, %66,6 olarak hesaplandı. 18F-FDG PET/BTnin lenf nodu metastazını saptamada duyarlılık, özgüllük, doğruluğu, PPD ve NPDsi sırasıyla %64,7, %100, %76, %100, %57,1 olarak hesaplandı. Sonuç: Mide kanserinin cerrahi öncesi evrelemesinde 18F-FDG PET/BTnin tanısal gücü BTye göre düşük olmakla birlikte kıyaslanabilir düzeydedir. Bölgesel lenf nodlarının değerlendirilmesinde, PPDnin yüksek olması nedeni ile BTde şüpheli lenf nodu saptanan hastaların değerlendirilmesinde yararlı olabilir. Diğer histolojik alt tiplere göre düşük düzeyde 18F-FDG tutulumu izlenen taşlı yüzük hücreli karsinomalı ve erken evre mide kanserli olguların cerrahi öncesi evrelemesinde 18F-FDG PET/BTnin rolü sınırlı görünmektedir.

Anahtar Kelime:

Konular: Radyoloji, Nükleer Tıp, Tıbbi Görüntüleme

Mide Kanserinin Primer Evrelemesinde 18F-FDG PET/BT nin Rolü

Öz:

Objective: The aim of this study is to explore the role of 18F-FDG PET/CT in the primary staging of gastric cancer in the comparison of ceCT as routine staging method and evaluate influencing parameters of 18F-FDG uptake. Methods: Thirty-one patients (mean age: 58.9±12.6) who underwent 18F-FDG PET/CT for primary staging of gastric cancer between June 2011 and June 2012 were included to the study. 18F-FDG PET/CT findings were compared with pathological reports in patients who underwent surgery following PET/CT. 18F-FDG PET/CT findings of primary lesions, lymph nodes and adjacent organs were compared with ceCT findings and pathological reports. Since 6 patients were accepted as inoperable according to 18F-FDG PET/CT and/or ceCT and/or laparotomy and/or laparoscopy findings, pathological confirmation could not be possible. Results: In the postoperative TNM staging of patients, while 1 (4%), 1 (4%), 4 (16%), 2 (8%), 12 (48%) and 5 (20%) patients were staged as T0, Tis, T1, T2, T3 and T4, respectively, 8 (32%), 6 (24%), 6 (24%) and 5 (20%) patients were N0, N1, N2 and N3 respectively. 18F-FDG PET/CT was totally normal in 2 patients. While primary tumors were FDG avid in 27 patients, in 17 and 6 patients FDG uptake was observed in perigastric lymph nodes and distant organs, respectively. Mean SUVmax of FDG avid tumors was calculated as 13.49±9.29 (3.00-44.60). However, SUVmax of lymph nodes was computed as 9.28±6.92 (2.80-29.10). According to sub-analysis of histopathological subtypes of primary tumors, SUVmax of adenocarsinomas was calculated as 15.16 (3.00-44.60), of signet ring cells as 9.90 (5.50-17.70), of adenocarcinomas with signet ring cell component as 11.27 (6.20-13.90) (p=0.721). In the comparison with histopathological examination while ceCT was TP, TN, FN in 23, 1 and 1 patients, 18F-FDG PET/CT was TP, FP, FN in 20, 1 and 4 patients, respectively. Sensitivity, specificity, accuracy, PPD and NPV of ceCT in the detection of lymph node metastasis was calculated as 83.3%, 75%, 80%, 87.5% and 66.6%, respectively. These parameters for 18F-FDG PET/CT were 64.7%, 100%, 76%, 100% and 57.1%. Conclusion: Despite lower sensitivity than ceCT, diagnostic power of 18F-FDG PET/CT in the preoperative staging of gastric cancer is acceptable. Because of its high PPV, it might be beneficial in the evaluation of patients with suspected lymph nodes. The role of 18F-FDG PET/CT seems to be limited in the early stage and signet ring cell carcinomas due to lower 18F-FDG uptake.

Anahtar Kelime:

Konular: Radyoloji, Nükleer Tıp, Tıbbi Görüntüleme

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	FILIK M, KİR K, aksel b, Soydal C, Ozkan E, KÜÇÜK N, İBİŞ E, AKGÜL H (2015). The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. , 15 - 20.
Chicago	FILIK MUSTAFA,KİR Kemal Metin,aksel bulent,Soydal Cigdem,Ozkan Elgin,KÜÇÜK NURİYE ÖZLEM,İBİŞ Erkan,AKGÜL Hikmet The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. (2015): 15 - 20.
MLA	FILIK MUSTAFA,KİR Kemal Metin,aksel bulent,Soydal Cigdem,Ozkan Elgin,KÜÇÜK NURİYE ÖZLEM,İBİŞ Erkan,AKGÜL Hikmet The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. , 2015, ss.15 - 20.
AMA	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. . 2015; 15 - 20.
Vancouver	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. . 2015; 15 - 20.
IEEE	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H "The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer." , ss.15 - 20, 2015.
ISNAD	FILIK, MUSTAFA vd. "The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer". (2015), 15-20.

APA	FILIK M, KİR K, aksel b, Soydal C, Ozkan E, KÜÇÜK N, İBİŞ E, AKGÜL H (2015). The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. Molecular Imaging and Radionuclide Therapy, 24(1), 15 - 20.
Chicago	FILIK MUSTAFA,KİR Kemal Metin,aksel bulent,Soydal Cigdem,Ozkan Elgin,KÜÇÜK NURİYE ÖZLEM,İBİŞ Erkan,AKGÜL Hikmet The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. Molecular Imaging and Radionuclide Therapy 24, no.1 (2015): 15 - 20.
MLA	FILIK MUSTAFA,KİR Kemal Metin,aksel bulent,Soydal Cigdem,Ozkan Elgin,KÜÇÜK NURİYE ÖZLEM,İBİŞ Erkan,AKGÜL Hikmet The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. Molecular Imaging and Radionuclide Therapy, vol.24, no.1, 2015, ss.15 - 20.
AMA	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. Molecular Imaging and Radionuclide Therapy. 2015; 24(1): 15 - 20.
Vancouver	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer. Molecular Imaging and Radionuclide Therapy. 2015; 24(1): 15 - 20.
IEEE	FILIK M,KİR K,aksel b,Soydal C,Ozkan E,KÜÇÜK N,İBİŞ E,AKGÜL H "The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer." Molecular Imaging and Radionuclide Therapy, 24, ss.15 - 20, 2015.
ISNAD	FILIK, MUSTAFA vd. "The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer". Molecular Imaging and Radionuclide Therapy 24/1 (2015), 15-20.