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The Impact of baseline 18F-FDG PET-CT on the management and outcome of patients with gastric cancer: a systematic review

Foley, Kieran G, Coomer, Will, Coles, Bernadette ORCID: and Bradley, Kevin M ORCID: 2022. The Impact of baseline 18F-FDG PET-CT on the management and outcome of patients with gastric cancer: a systematic review. British Journal of Radiology 85 (1139) , 20220437. 10.1259/bjr.20220437

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Objective: CT and staging laparoscopy are routinely used to stage patients with gastric cancer, however the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with CT (PET-CT) is uncertain. This systematic review synthesised the evidence regarding the impact of baseline PET-CT staging on treatment decisions and patient outcomes. Methods: Systematic database searches were performed without date restriction. Studies reporting data in patients with gastric adenocarcinoma who underwent radiological staging were included. One reviewer screened titles and abstracts for suitability and two reviewers extracted data from included articles. Primary outcome was the reported change in management after PET-CT. Secondary outcomes were the rates of recurrence and overall survival between patients staged with and without PET-CT. Risk of bias was assessed using the ROBINS-I tool. PROSPERO registration (CRD42022304314). Results: Data from 11 studies recruiting 2101 patients between 2012 and 2021 were included. PET-CT was performed in 1422 patients. Change of management varied between 3% and 29% of cases. No studies compared recurrence or survival rates between patients staged with or without PET-CT. Adenocarcinoma of intestinal subtype tended to be more FDG-avid compared to diffuse or signet-ring subtypes. No randomised data existed, and studies were considered low quality with high risk of bias. Conclusion: Evidence for the additional value of PET-CT in the gastric cancer staging pathway is limited. All studies reported a positive impact by preventing those with undetected metastatic disease on CT undergoing futile surgery. Future national guidelines should consider routine staging PET-CT in gastric cancer.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Academic & Student Support Service
Publisher: British Institute of Radiology
ISSN: 0007-1285
Date of First Compliant Deposit: 4 October 2022
Date of Acceptance: 11 September 2022
Last Modified: 30 Nov 2022 08:53

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