Gastric Cancer

Gastric cancer is the second most common cause of cancer death in the world, with an overall 5-year survival rate less than 25%.240 The leading cause for the development of gastric cancer is repeated infection with Helicobacter pylori.

There two different types: the intestinal type, which predominantly involves the distal stomach (most common in Asia), and the diffuse or signet-ring type, which mainly involves the proximal stomach (most common in Western countries).

Tumors consisting of signet-ring cells or with large amounts of mucin are frequently false negative by FDG-PET, probably because of a lower expression of glucose transporters in these types of tumors and a lower tumor cell density.241,242 Even large tumors with a diameter of several centimeters can be falsely negative on FDG-PET if the tumor cells demonstrate low metabolic activity.243

Yeung et al.244 studied 23 patients with gastric cancer and found that FDG-PET had a sensitivity of 93% for detection of gastric cancer, a specificity of 100% for detection of local recurrence, but low sensitivity (22%) and high specificity (97%) for detection of metastatic disease in intraabdominal lymph mode stations.

Stahl et al.241 reported higher detection rates in the intestinal type (83%) compared with the nonintestinal type (41%). The SUV was greater in the intestinal type (6.7 ± 3.4) than in the nonintestinal type (4.8 ± 2.8). Nonmucinous tumors had higher SUVs (7.2 ± 3.2) than the mucinous ones (3.9 ± 2.1), and the same was true for grade 2 tumors, which had higher FDG uptake than the grade 3 tumors.

Mochiki et al.245 described the existence of a relationship between the intensity of FDG uptake and survival, which did not agree with the results of Stahl and coworkers.241 Yoshioka et al.246 demonstrated the usefulness of FDG-PET in detecting metastatic disease in the liver, lungs, and lymph nodes, but it was not useful for detection of osseous metastases and peritoneal or pleural carcinomatosis. De Potter et al.243 reported in a study of 33 patients that the sensitivity, speci

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