The Role of PET-CT in Gastric Cancer – A Narrative Review
Background: Gastric cancer is one of the most common and leading causes of cancer death worldwide, with an increasing risk and prevalence. Although the usage of 18-FDG PET-CT in gastric cancer evaluation remains a matter of debate and is not consistently recommended by international guidelines, our descriptive review aims to highlight its actual role in the diagnostic accuracy, staging, therapeutic management, and relapse monitoring of this malignancy.
Methods: The current research was conducted using scholarly databases including PubMed, Scopus, and Google Scholar by searching useful science journals, references, and abstracts on the topic. The keywords used were “gastric cancer” AND “PET-CT”.
Results: 18-FDG PET-CT remains a promising method with increasing clinical utility not only across a wide variety of malignancies, but also among gastric cancer patients.
Conclusions: We are certain that with further improvements, this technique could improve the diagnosis and evaluation of gastric cancer, and make it more approachable and accurate.
gastric cancer (GC), PET-CT, 18-FDG PET-CT, 18F-FDG uptake, ceCT (contrast-enhanced CT)
 Waddell, T., Verheij, M., Allum, W., et al. (2013). Gastric cancer+: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, vol. 24, no. 6.
 Yamada, T., Alpers, D. H., Kalloo, A. N., et al. (2009). Textbook of Gastroenterology (5th ed.), vol. 1–2.
 De Raffele, E., Mirarchi, M., Cuicchi, D., et al. (2017). Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer. World Journal of Gastroenterology, vol. 23, no. 38, pp. 6923–6926.
 Wu, C. X. and Zhu, Z. H. (2014). Diagnosis and evaluation of gastric cancer by positron emission tomography. World Journal of Gastroenterology, vol. 20, no. 16, pp. 4574–4585.
 Song, B. I., Kim, H. W., Won, K. S., et al. (2015). Preoperative standardized uptake value of metastatic lymph nodes measured by 18F-FDG PET/CT improves the prediction of prognosis in gastric cancer. Medicine, vol. 94, no. 26.
 Malibari, N., Hickeson, M., and Lisbona R. (2015). PET/computed tomography in the diagnosis and staging of gastric cancers. PET Clinics, vol. 10, no. 3, pp. 311–326.
 Atay-Rosenthal S., Wahl, R. L., and Fishman, E. K. (2012). PET/CT findings in gastric cancer: potential advantages and current limitations. Imaging in Medicine, vol. 4, no. 2. Retrieved from: https://www.openaccessjournals.com/articles/petct-findings-in-gastric-cancer-potential-advantages-and-current-limitations.html?fbclid=IwAR1fmJh5yTSlzly2PpLkcckmVZn0SpLu4za9zeLJ866agHGZvRLvsPmFj5I [accessed on December 16, 2019].
 Mukai, K., Ishida, Y., Okajima, K., et al. (2006). Usefulness of preoperative FDG-PET for detection of gastric cancer. Gastric Cancer, vol. 9, no. 3, pp. 192–196.
 Filik, M., Kir, K. M., Aksel, B., et al. (2015). The role of 18F-FDG PET/CT in the Primary staging of gastric cancer. Molecular Imaging and Radionuclide Therapy, vol. 24, no. 1, pp. 15–20.
 Yeung, H. W. D., Macapinlac, H., Karpeh, M., et al. Accuracy of FDG-PET in gastric cancer. preliminary experience. Molecular Imaging and Biology, vol. 1, no. 4, pp. 213–221.
 Kim, E. Y., Lee, W. J., Choi, D., et al. (2011). The value of PET/CT for preoperative staging of advanced gastric cancer: comparison with contrast-enhanced CT. European Journal of Radiology, vol. 79, no. 2, pp. 183–188.
 Shimizu, K., Ito, K., Matsunaga, N., et al. (2005). Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation. American Journal of Roentgenology, vol. 185, no. 5, pp. 1152–1158.
 Perlaza, P., Ortín, J., Pagès, M., et al. (2018). Should 18F-FDG PET/CT Be routinely performed in the clinical staging of locally advanced gastric adenocarcinoma? Clinical Nuclear Medicine, vol. 43, no. 6, pp. 402–410.
 Yun, M., Lim, J. S., Noh, S. H., et al. (2005). Lymph node staging of gastric cancer using 18F-FDG PET: a comparison study with CT. Journal of Nuclear Medicine, vol. 46, no. 10, pp. 1582–1588.
 Tamura, S., Takeno, A., and Miki, H. (2011). Lymph node dissection in curative gastrectomy for advanced gastric cancer. International Journal of Surgical Oncology, vol. 2011, pp. 1–8.
 Kwee, R. M. and Kwee, T. C. (2009). Imaging in assessing lymph node status in gastric cancer. Gastric Cancer, vol. 12, no. 1. pp. 6–22.
 Seevaratnam, R., Cardoso, R., McGregor, C., et al. (2012). How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis. Gastric Cancer, vol. 15, no.1, pp. S3–S18.
 Ha, T. K., Choi, Y. Y., Song, S. Y., et al. (2011). F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer. Journal of Korean Surgical Society, vol. 81, no. 2, pp. 104–110.
 Hopkins, S. and Yang, G. Y. (2011). FDG PET imaging in the staging and management of gastric cancer. Journal of Gastrointestinal Oncology, vol. 2, no. 1, pp. 39–44.
 Chung, H. W., Lee, E. J., Cho, Y.-H., et al. (2010). High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma. Journal of Cancer Research and Clinical Oncology, vol. 136, no. 12, pp. 1929–1935.
 Ma, D. W., Kim, J.-H., Jeon, T. J., et al. (2013). 18F-fluorodeoxyglucose positron emission tomography-computed tomography for the evaluation of bone metastasis in patients with gastric cancer. Digestive and Liver Disease, vol. 45, no. 9, pp. 769–775.
 Wang, Z. and Chen, J. Q. (2011). Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review. BMC Gastroenterology, vol. 11, p. 19.
 Smyth, E., Schöder, H., Strong, V. E., et al. (2012). 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. Cancer, vol. 118, no. 22. pp. 5481–5488.
 Yun, M. (2014). Imaging of gastric cancer metabolism using 18 F-FDG PET/CT. Journal of Gastric Cancer, vol. 14, no. 1, pp. 1–6.
 Cayvarlı, H., Bekiş, R., Akman, T., et al. (2014). The role of 18F-FDG PET/CT in the evaluation of gastric cancer recurrence. Molecular Imaging and Radionuclide Therapy, vol. 23, no. 3, pp. 76–83.
 Lee, J. W., Lee, S. M., Lee, M. S., et al. (2012). Role of 18F-FDG PET/CT in the prediction of gastric cancer recurrence after curative surgical resection. European Journal of Nuclear Medicine and Molecular Imaging, vol. 39, no. 9, pp. 1425–1434.
 Sim, S. H., Yu, J. K., Oh D.-Y., et al. (2009). The role of PET/CT in detection of gastric cancer recurrence. BMC Cancer, vol. 9, p. 73.
 Wu, L. M., Hu, J. N., Hua, J., et al. (2012). 18F-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer: a systematic review and meta-analysis. European Journal of Gastroenterology & Hepatology, vol. 27, no. 3, pp. 472–480.
 Zou, H. and Zhao, Y. (2013). 18FDG PET-CT for detecting gastric cancer recurrence after surgical resection: a meta-analysis. Surgical Oncology, vol. 22, no. 3, pp. 162–166.
 Bilici, A., et al. (2011). The role of 18F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: can the results of FDG PET/CT influence patients’ treatment decision making? European Journal of Nuclear Medicine and Molecular Imaging, vol. 38, no. 1, pp. 64–73.
 Dassen, A. E., Lips, D. J., Hoekstra, C. J., et al. (2009). FDG-PET has no definite role in preoperative imaging in gastric cancer. European Journal of Surgical Oncology, vol. 35, no. 5, pp. 449–455.