Ge DF, Ren H, Yang ZC, Zhao SX, Cheng ZT, Wu DD, Zhang B. Application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in recurrent anastomotic tumors after surgery in digestive tract tumors. World J Gastrointest Surg 2024; 16(8): 2474-2483 [PMID: 39220071 DOI: 10.4240/wjgs.v16.i8.2474]
Corresponding Author of This Article
Bin Zhang, PhD, Doctor, Department of Cardiothoracic Surgery, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Nanjing 210023, Jiangsu Province, China. 13901599064@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2474-2483 Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2474
Application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in recurrent anastomotic tumors after surgery in digestive tract tumors
Deng-Feng Ge, Hao Ren, Zi-Chen Yang, Shou-Xiang Zhao, Zhen-Ting Cheng, Bin Zhang, Department of Cardiothoracic Surgery, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Da-Da Wu, Department of Gastrointestinal Surgery, Shanghai Sixth People’s Hospital, Shanghai 250063, China
Author contributions: Ge DF wrote the manuscript; Ren H, Yang ZC, Zhao SX, Cheng ZT, and Wu DD collected the data; Zhang B guided the study; and all authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Institutional review board statement: This study has been approved by the Human Medical Research Ethics Committee of our hospital.
Informed consent statement: Informed consent of patients and their families was obtained for this study, and informed consent for treatment was signed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data from this study may be provided upon reasonable request and shared upon submission and approval of the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Zhang, PhD, Doctor, Department of Cardiothoracic Surgery, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Nanjing 210023, Jiangsu Province, China. 13901599064@163.com
Received: March 11, 2024 Revised: June 13, 2024 Accepted: June 26, 2024 Published online: August 27, 2024 Processing time: 158 Days and 2.7 Hours
Abstract
BACKGROUND
This study was to investigate the application value of whole-body dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging in recurrent anastomotic tumors of digestive tract after gastric and esophageal cancer surgery. Postoperative patients with gastric and esophageal cancer have a high risk of tumor recurrence, and traditional imaging methods have certain limitations in early detection of recurrent tumors. Whole-body dynamic 18F-FDG PET/CT imaging, due to its high sensitivity and specificity, can provide comprehensive information on tumor metabolic activity, which is expected to improve the early diagnosis rate of postoperative recurrent tumors, and provide an important reference for clinical treatment decision-making.
AIM
To investigate the clinical value of whole-body dynamic 18F-FDG PET/CT imaging in differentiating anastomotic recurrence and inflammation after the operation of upper digestive tract tumors.
METHODS
A retrospective analysis was performed on 53 patients with upper digestive tract tumors after operation and systemic dynamic 18F-FDG PET/CT imaging indicating abnormal FDG uptake by anastomosis, including 29 cases of gastric cancer and 24 cases of esophageal cancer. According to the follow-up results of gastroscopy and other imaging examinations before and after PET/CT examination, the patients were divided into an anastomotic recurrence group and anastomotic inflammation group. Patlak multi-parameter analysis software was used to obtain the metabolic rate (MRFDG), volume of distribution maximum (DVmax) of anastomotic lesions, and MRmean and DVmean of normal liver tissue. The lesion/background ratio (LBR) was calculated by dividing the MRFDG and DVmax of the anastomotic lesion by the MRmean and DVmean of the normal liver tissue, respectively, to obtain LBR-MRFDG and LBR-DVmax. An independent sample t test was used for statistical analysis, and a receiver operating characteristic curve was used to analyze the differential diagnostic efficacy of each parameter for anastomotic recurrence and inflammation.
RESULTS
The dynamic 18F-FDG PET/CT imaging parameters MRFDG, DVmax, LBR-MRFDG, and LBR-DVmax of postoperative anastomotic lesions in gastric cancer and esophageal cancer showed statistically significant differences between the recurrence group and the inflammatory group (P < 0.05). The parameter LBR-MRFDG showed good diagnostic efficacy in differentiating anastomotic inflammation from recurrent lesions. In the gastric cancer group, the area under the curve (AUC) value was 0.935 (0.778, 0.993) when the threshold was 1.83, and in the esophageal cancer group, the AUC value was 1. When 86 is the threshold, the AUC value is 0.927 (0.743, 0.993).
CONCLUSION
Whole-body dynamic 18F-FDG PET/CT imaging can accurately differentiate the diagnosis of postoperative anastomotic recurrence and inflammation of gastric cancer and esophageal cancer and has the potential to be an effective monitoring method for patients with upper digestive tract tumors after surgical treatment.
Core Tip: This study evaluated the efficacy of whole-body dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging in the diagnosis of recurrent anastomotic tumors of the digestive tract in postoperative patients with gastric and esophageal cancer. This study evaluated the sensitivity and specificity of the whole body dynamic 18F-FDG PET/CT scan in patients with recurrent tumors by analyzing the image data and combining with clinicopathological data. The accuracy and clinical application value of this imaging technology in early identification of recurrent tumors and its potential role in postoperative patient management are explored, with a view to providing new diagnostic tools and methods for clinical practice.
