Limitations in the use of 18F-FDG PET in the pre-operative staging of gastric cancer: A case series

INTRODUCTION Positron emission tomography (PET) is a mainstay in the preoperative evaluation of various cancers. In gastric cancer however, its role in the initial staging remains contentious. Presented is a case series of three gastric patients wherein the use of fluorodeoxyglucose (18F-FDG) PET/CT (computer tomography) as part of the initial staging was inconsequential to treatment, demonstrating its limited role in the staging of primary gastric cancer. METHODS We analyzed retrospective data from 12/1/2010 to 10/31/2016 of patient with gastric cancer whose initial staging included a PET/CT. Only patients 18 years and older with gastric and gastro-oesophageal junction cancers were included. The data was derived from a single institution. Management of patients involved both an academic institution and a community practice. RESULTS Of the three cases reported, an FDG-avid mass with minimal FDG uptake was reported in a single case and no FDG-avid lesion was reported in the other two. Neither of the patients underwent an endoscopic ultrasound for lack of availability. CONCLUSION While various imaging studies such as endoscopic ultrasound have an established role in the initial staging, the role of FDG-PET is yet to be established and its routine use remains contentious. Based on our clinical experience and review of the literature, we believe FDG-PET/CT imaging is of limited clinical and cost effective value in the initial staging workup of gastric cancer.