Original investigationPrediction of Metastatic Disease and Survival in Patients with Gastric and Gastroesophageal Junction Tumors: The Incremental Value of PET-CT over PET and the Clinical Role of Primary Tumor Volume Measurements
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Patients
Study subjects were 59 patients with adenocarcinomas of the GEJ, including 36 patients with subcardial gastric carcinomas (type III according to the Siewert classification) and 23 patients with tumors of the cardia (type II Siewert) (1). The study was compliant with the Health Insurance Portability and Accountability Act, and approval from the institutional review board was obtained.
Patients were primarily grouped into carcinomas with distant metastasis (M1) and those who were metastasis-free
Association between Tumor Volume Parameters and Risk of Metastatic Disease
Of the 59 patients, 25 had a metastatic tumor stage, whereas 34 were free of distant metastasis. Of the 25 patients with metastasis, 21 had M1b stage (metastasis to visceral organs), and 4 patients had M1a stage (metastasis to distant lymph nodes: celiac lymph nodes). Primary tumor volume and mean and maximum SUV of tumor volume were measured both on PET-CT and PET (Table 2). As shown in Table 2, tumor volume yielded higher sensitivity and specificity than SUVs both on PET-CT and PET
Discussion
The present study shows that fused PET-CT is more accurate than PET (reviewed side by side with CT) for assessing distant metastatic sites of GEJ tumors. On a patient-based analysis, the sensitivity of PET-CT and PET can be further increased by measuring primary tumor volume. The combination of a visual analysis and a quantitative analysis (tumor volume) resulted in a sensitivity of 96% and a specificity of 94% for defining M1 disease.
Detection of metastases in esophageal and gastric carcinomas
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