Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Comparison between FDG Uptake and Clinicopathologic and Immunohistochemical Parameters in Pre-operative PET/CT Scan of Primary Gastric Carcinoma

원발성 위암 환자의 치료 전 PET/CT 스캔에서 FDG 섭취 정도와 임상병리학적 및 면역조직화학적 지표들과의 비교

  • Han, Eun-Ji (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Choi, Woo-Hee (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Chung, Yong-An (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Kim, Ki-Jun (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Maeng, Lee-So (Department of Hospital Pathology, College of Medicine, The Catholic University of Korea) ;
  • Sohn, Kyung-Myung (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Jung, Hyun-Suk (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Sohn, Hyung-Sun (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Chung, Soo-Kyo (Department of Radiology, College of Medicine, The Catholic University of Korea)
  • 한은지 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 최우희 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 정용안 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 김기준 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 맹이소 (가톨릭대학교 의과대학 병원병리학교실) ;
  • 손경명 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 정현석 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 손형선 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 정수교 (가톨릭대학교 의과대학 방사선과학교실)
  • Published : 2009.02.28
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Abstract

Purpose: The purpose of this study was to find out what clinicopathologic or immunohistochemical parameter that may affect FDG uptake of primary tumor in PET/CT scan of the gastric carcinoma patient. Materials and Methods: Eighty-nine patients with stomach cancer who underwent pre-operative FDG PET/CT scans were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The clinicopathologic results such as depth of invasion (T stage), tumor size, lymph node metastasis, tumor differentiation and Lauren's classification and immunohistochemical markers such as Ki-67 index, expression of p53, EGFR, Cathepsin D, c-erb-B2 and COX-2 were reviewed. Results: Nineteen out of 89 gastric carcinomas showed imperceptible FDG uptake on PET/CT images. In cases with perceptible FDG uptake in primary tumor, SUVmax was significantly higher in T2, T3 and T4 tumors than T1 tumors ($5.8{\pm}3.1$ vs. $3.7{\pm}2.1$, p=0.002). SUVmax of large tumors (above or equal to 3 cm) was also significantly higher than SUVmax of small ones (less than 3 cm) ($5.7{\pm}3.2$ vs. $3.7{\pm}2.0$, p=0.002). The intestinal types of gastric carcinomas according to Lauren showed higher FDG uptake compared to the non-intestinal types ($5.4{\pm}2.8$ vs. $3.7{\pm}1.3$, p=0.003). SUVmax between p53 positive group and negative group was significantly different ($6.0{\pm}2.8$ vs. $4.4{\pm}3.0$, p=0.035). No significant difference was found in presence of LN metastasis, tumor differentiation, Ki-67 index, and expression of EGFR, Cathepsin D, c-erb-B2 and COX-2. Conclusion: T stage of gastric carcinoma influenced the detectability of gastric cancer on FDG PET PET/CT scan. When gastric carcinoma was perceptible on PET/CT scan, T stage, size of primary tumor, Lauren's classification and p53 expression were related to degree of FDG uptake in primary tumor.

목적: 원발성 위암 환자의 PET/CT 스캔에서 FDG 섭취에 영향을 주는 임상병리학적 및 면역조직화학적 지표들이 있는지 알아보고자 하였다. 대상 및 방법: 본원에 내원하여 수술 전 FDG PET/CT 스캔을 시행한 89명의 위암환자들을 대상으로 하였다. PET/CT 영상에서 원발 종양의 SUVmax를 구한 후 침범 깊이(T기),종양 크기, 림프절전이, 종양 분화, Lauren의 분류, Ki-67 지수, p53, EGFR, Cathepsin D, c-erb-B2. COX-2의 발현과 같은 임상병리학적 및 면역조직화학적 지표들과의 상관 관계를 분석하였다. 결과: 89예의 위암 중 19예에서는 PET/CT 영상에서 인지 가능한 FDG 섭취가 없었는데, 이 19예 중 16예는 원발 종양의 침범 깊이가 점막하 이내에 국한된 경우였다. 위암의 FDG섭취 정도는 T기가 T2 이상일 때가 T1일 때보다 유의하게 높았고($5.8{\pm}3.1$ vs. $3.7{\pm}2.1$, p=0.002), 위암의 크기가 3 cm 이상일 경우가 3 cm 미만일 경우보다 유의하게 높았다($5.7{\pm}3.2$ vs. $3.7{\pm}2.0$, p=0.002) Lauren의 분류에 따른 장형 위암에서 장형이 아닐 때보다 높은 SUVmax를 보였다($5.4{\pm}2.8$ vs. $3.7{\pm}1.3$, p=0.003). 원발 종양의 SUVmax는 p53 양성인 경우가 음성인 경우보다 의미 있게 높았다($6.0{\pm}2.8$ vs. $4.4{\pm}3.0$, p=0.035). 그 외 림프절 전이 유무, 종양 분화, Ki-67 지수, EGFR, Cathepsin D, c-erb-B2 그리고 COX-2 같은 다른 지표들은 원발성 위암의 SUVmax와 의미 있는 상관 관계가 없었다. 결론: 원발성 위암의 침범 깊이(T기)는 FDG PET/CT 스캔에서의 위암 발견율에 영향을 주었다. 위암이 PET/CT스캔에서 인지 가능한 FDG 섭취를 보일 경우 T기, 종양의 크기, Lauren의 분류에 따른 조직형, 그리고 p53의 발현 정도는 원발성 위암의 FDG 섭취와 유의한 상관 관계가 있었다.

Keywords

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