Review18FDG PET-CT for detecting gastric cancer recurrence after surgical resection: A meta-analysis
Introduction
Gastric cancer is the second most common cause of cancer death worldwide [1]. Within the Asian region, the incidence of gastric cancer is high, and it is a major health burden in the Asian region [2]. Complete resection of gastric cancer is considered potentially curative. But about 80% of the patients die within a short period of time from recurrence after curative surgery [3]. Early detection of recurrence is important for evaluating the treatment outcome and choosing the most effective management.
Now various imaging methods (such as tumor markers, endoscopy or computed tomography [CT]) have been used to detect recurrence of gastric cancer after curative surgery. However, endoscopy cannot detect extra-luminal recurrence. And tumor markers cannot localize the recurrence site and [4]. Contrast-enhanced CT is the most frequently used imaging modality for the detection of gastric cancer recurrence [4], [5]. However, CT has a notable limitation on the detection of cancer recurrence. It cannot reflect the presence and viability of cancer recurrence precisely because its diagnostic ability is dependent only on morphological changes of the involved organs and distorted anatomical structures.
18F-fluorodeoxyglucose positron emission tomography (18FDG PET) is an imaging tool that reflects tumor metabolism. Recently, integrated PET with CT (PET-CT) has been introduced and is expected to give us more precise anatomical data with metabolic information. Now many studies about 18FDG PET-CT for detection of gastric cancer recurrence after surgical resection have been reported. But results from these studies are controversial because of the limited sample size of single studies [6], [7], [8], [9]. Here, we performed a meta-analysis to evaluate the accuracy of 18FDG PET-CT for diagnosis of gastric cancer recurrence after surgical resection.
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Literature search
Two investigators (H.Z.Z and Y.Q.Z) performed a systematic literature search of the MEDLINE and EMBASE databases to identify relevant studies (last update May 3, 2013), with the following combination of search terms: (a) gastric neoplasm OR gastric cancer OR gastric carcinoma; (b) CT OR computed tomography; and (c) PET OR positron emission tomography. There was no language restriction on the initial search. The scope of literature search was enlarged on the basis of the reference lists of all
Literature identification
The electronic search yielded 279 articles; 267 were excluded upfront by reading the abstract because they did not present any diagnostic information. We screened in full-text 12 articles and rejected 4 articles; 8 articles [6], [7], [8], [9], [14], [15], [16], [17] were eligible for meta-analysis. Reasons for exclusion are listed in Fig. 1. A total of 500 patients were analyzed for the accuracy of PET-CT. In eight articles (100%), the study design was retrospective (Table 1).
Study quality
We assessed the
Discussion
The early diagnosis of gastric cancer recurrence after surgical resection is crucial for choosing the most effective management and evaluating the treatment outcome. We considered 8 PET-CT studies (500 patients) for inclusion in this meta-analysis. And the pooled sensitivity and specificity of PET-CT were 0.86 (95% CI = 0.71–0.94) and 0.88 (95% CI = 0.75–0.94). This meta-analysis showed that 18FDG PET-CT had moderate sensitivity and specificity for diagnosis of gastric cancer recurrence after
Conflict of interest statement
The authors declare that they have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing their contribution.
Acknowledgment
No external fund was received in this study.
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