# Application of PET/CT in Preoperative Evaluation and Diagnosis of Gastric Cancer

Authors: Xin Zhou; Yongpeng Zhang; Xipeng Zhao; Lin Zhou; Xia Jia; Libo Pan
Journal: Computational and Mathematical Methods in Medicine
 (2022)

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## Abstract

The aim study to study the significance of pet clinical examination image technology for early gastric mucosal adenocarcinoma, improve the accuracy and accuracy of image examination results of gastric cancer, and provide important reference significance and value for early treatment. Study methods, we used the experimental method of clinical medicine to obtain some reference data through the intervention of different image examinations on experimental patients of different groups and stages, These data show that the use of PET-CT imaging can improve the one-year survival rate of patients and reduce the one-year recurrence rate. Lymphatic metastasis rate and hematogenous metastasis rate, so as to highlight the advantages of PET-CT imaging.


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## Body

## 1. Introduction

Pet is called positron emission tomography (PET). The inspection principle of pet clinical examination imaging technology is roughly that some short-lived substances that must be metabolized by living organisms, such as protein and glucose, release positrons in the process of decay. A positron annihilates when it encounters an electron after traveling a few tenths to a few millimeters, resulting in a pair of photons with energy of 511kev in the opposite direction (180 degrees) (based on pair production) This pair of photons is captured by a highly sensitive camera and corrected by a computer for scattering and random information. After the same analysis and processing of different positrons, we can get a three-dimensional image of the aggregation in the organism [1–4]. This is the principle of pet clinical examination imaging technology. It has the advantages of high sensitivity, high specificity and whole-body imaging, that is, safety Moreover, it is the only new imaging technology that can display biomolecular metabolism, receptor and neurotransmitter activities in vivo. It has been widely used in the diagnosis and differential diagnosis of a variety of diseases, condition judgment, curative effect evaluation, organ function research and new drug development [5, 6]. Gastric cancer It is a malignant tumor originating from gastric mucosal epithelium. In this study, the concept of gastric cancer specifically refers to gastric mucosal adenocarcinoma. Gastric mucosal adenocarcinoma accounts for a large proportion of malignant gastric cancer, accounting for about 95%. Its etiology is not clear, but it is certain that the primary carcinogenic factors of gastric ulcer, Helicobacter pylori infection and gastric mucus associated lymphoid tissue lymphoma can lead to the lesions of gastric mucosal adenocarcinoma. It is easy to The patients mainly include those who like high salt and heavy taste, those who smoke and drink, those who have a family history of stomach diseases, those who are introverted and stuffy. Moreover, cauliflower lesions of gastric cancer are easier to find, but erosive lesions, atrophic lesions and diffuse lesions are more difficult to find. General imaging examination can only detect the symptoms of gastric cancer with lesions, but for gastric cancer without lesions, the general imaging examination can not find out [7–10]. However, the application of pet clinical examination imaging technology can show the erosive lesions, atrophic lesions and diffuse lesions through imaging. The application of PET imaging in gastric cancer is also discussed in the study on the relationship between PET/CT imaging and the expression of HER2 and MDR1 in gastric cancer published by [11, 12].The morbidity analysis of the different age groups is shown in Figure1:Figure 1
Analysis of incidence rate of different age groups.(TData source: WTO public data)In Figure1: Incidence rate incidence rate incidence rate incidence rate of male and female gastric cancer in different ages and surnames is analyzed according to WTO statistics. The data show that the incidence of gastric cancer is not much difference between men and women before 45 years old. After 45 years old, the incidence of male is increasing linearly, far greater than that of female. This study is mainly to study the application of pet clinical examination imaging technology in the examination of gastric mucosal adenocarcinoma. Compared with electronic gastroscope and etc as the reference group, it shows the advantages of pet, which is supported by clinical trial data. The following is mainly to demonstrate the advantages of pet.


## 2. Data and Methods

### 2.1. General Information of Patients

268 patients with gastric mucosal adenocarcinoma who completed preliminary chemotherapy in the Department of Gastroenterology of our hospital before June 2020, including 124 males, aged 36~65 years, with an average age of 52.3 ± 4.2 years, and 144 females, aged 44~71 years, with an average age of 56.1 ± 4.6 years.Case selection: all selected patients were primary cancer of gastric mucosal adenocarcinoma, which were in stage I, stage I-II and stage II. All patients successfully completed the preliminary chemotherapy. The course of chemotherapy was 4 ~ 7 courses, 6 days of chemotherapy per month and 1 day of nutritional treatment. After chemotherapy, all patients met the WHO (World Health Organization) effective standard for chemotherapy of gastric mucosal adenocarcinoma [13–16]. Case exclusion: Patients above stage II-III and patients with lymphatic metastasis and hematogenous metastasis were excluded. Patients with ineffective chemotherapy and chemotherapy death were excluded. Patients with secondary gastric cancer and patients with multiple carcinoma in situ were excluded. Patients with hematopoietic insufficiency and other functional diseases that may affect the results of this study were excluded.


### 2.2. Grouping, Diagnosis and Observation Methods

All patients were divided into stage I 105 cases, stage I-II 87 cases and stage II 76 cases. The patients were randomly divided into observation group and reference group. All patients in the observation group underwent electronic gastroscopy, ect and PET-CT to compare the respective sensitivity and comprehensive sensitivity of the three examination results. The reference group underwent electronic gastroscopy and ect to compare the respective sensitivity and comprehensive sensitivity of the two examination results. After course grouping and random grouping, the data of gender, age, course of disease and pathology were analyzed by bivariate t-test in SPSS software, t >10.000, P <0.05, with credible statistical consistency. The stage of disease course and other related diagnostic methods met the standards of who and idc-11. Both groups were treated with radical gastrectomy combined with chemotherapy. The treatment plan, medication principle and nursing path are completely consistent. In addition to observing the sensitivity and specificity of the examination results, the one-year survival rate, recurrence rate, lymphatic metastasis rate and blood metastasis rate of the two groups were compared to study the impact of different examination methods on the quality of prognosis.


### 2.3. Statistical Methods

The “counting (proportion) method” is used to calculate the counting data, and the “mean ± standard deviation method” is used to calculate the measurement data.The calculation formula of mean and standard deviation is shown in formula (1):
(1)σ=1n−1∑i=1nxi−x¯2,x¯=1n∑i=1nxiAmong:σ Is the standard deviation;x¯Is the arithmetic mean of statistical sequence x; N is the number of statistical samples; x_ I is the ith statistical value in the statistical series X;Bivariate t-test was used to compare the data differences, in which: value is t value. When T <10.000, it is considered that there is a statistical difference. The smaller the T value, the greater the statistical difference; Log value isp value. When p <0.05, it is considered to have statistical reliability, and when p <0.01, it is considered to have statistical significance; The calculation formula of T value is shown in formula (2):
(2)tValue=∑i=1nxi−x~i∑i=1nxi−x¯Among:x~i is the regressed xi control value; tValue is the output result of T value; Other mathematical symbols have the same meaning as formula (1);


## 2.1. General Information of Patients

268 patients with gastric mucosal adenocarcinoma who completed preliminary chemotherapy in the Department of Gastroenterology of our hospital before June 2020, including 124 males, aged 36~65 years, with an average age of 52.3 ± 4.2 years, and 144 females, aged 44~71 years, with an average age of 56.1 ± 4.6 years.Case selection: all selected patients were primary cancer of gastric mucosal adenocarcinoma, which were in stage I, stage I-II and stage II. All patients successfully completed the preliminary chemotherapy. The course of chemotherapy was 4 ~ 7 courses, 6 days of chemotherapy per month and 1 day of nutritional treatment. After chemotherapy, all patients met the WHO (World Health Organization) effective standard for chemotherapy of gastric mucosal adenocarcinoma [13–16]. Case exclusion: Patients above stage II-III and patients with lymphatic metastasis and hematogenous metastasis were excluded. Patients with ineffective chemotherapy and chemotherapy death were excluded. Patients with secondary gastric cancer and patients with multiple carcinoma in situ were excluded. Patients with hematopoietic insufficiency and other functional diseases that may affect the results of this study were excluded.


## 2.2. Grouping, Diagnosis and Observation Methods

All patients were divided into stage I 105 cases, stage I-II 87 cases and stage II 76 cases. The patients were randomly divided into observation group and reference group. All patients in the observation group underwent electronic gastroscopy, ect and PET-CT to compare the respective sensitivity and comprehensive sensitivity of the three examination results. The reference group underwent electronic gastroscopy and ect to compare the respective sensitivity and comprehensive sensitivity of the two examination results. After course grouping and random grouping, the data of gender, age, course of disease and pathology were analyzed by bivariate t-test in SPSS software, t >10.000, P <0.05, with credible statistical consistency. The stage of disease course and other related diagnostic methods met the standards of who and idc-11. Both groups were treated with radical gastrectomy combined with chemotherapy. The treatment plan, medication principle and nursing path are completely consistent. In addition to observing the sensitivity and specificity of the examination results, the one-year survival rate, recurrence rate, lymphatic metastasis rate and blood metastasis rate of the two groups were compared to study the impact of different examination methods on the quality of prognosis.


## 2.3. Statistical Methods

The “counting (proportion) method” is used to calculate the counting data, and the “mean ± standard deviation method” is used to calculate the measurement data.The calculation formula of mean and standard deviation is shown in formula (1):
(1)σ=1n−1∑i=1nxi−x¯2,x¯=1n∑i=1nxiAmong:σ Is the standard deviation;x¯Is the arithmetic mean of statistical sequence x; N is the number of statistical samples; x_ I is the ith statistical value in the statistical series X;Bivariate t-test was used to compare the data differences, in which: value is t value. When T <10.000, it is considered that there is a statistical difference. The smaller the T value, the greater the statistical difference; Log value isp value. When p <0.05, it is considered to have statistical reliability, and when p <0.01, it is considered to have statistical significance; The calculation formula of T value is shown in formula (2):
(2)tValue=∑i=1nxi−x~i∑i=1nxi−x¯Among:x~i is the regressed xi control value; tValue is the output result of T value; Other mathematical symbols have the same meaning as formula (1);


## 3. Results

### 3.1. Comparison of Sensitivity and Specificity

Comparison of the sensitivity and specificity of the different inspection methods are shown in Table1:Table 1
Comparison of sensitivity and specificity of different examination methods.
Examination methods \ course and stageSensitivitySpecificityPhase I/I-IIPhase IIPhase I/I-IIPhase IIElectronic gastroscope78.6 ± 0.680.6 ± 0.579.3 ± 0.681.4 ± 0.6ECT92.3 ± 0.994.5 ± 0.893.6 ± 0.795.3 ± 0.6PET-CT96.9 ± 0.898.4 ± 0.797.1 ± 0.898.9 ± 0.8Reference group synthesis96.3 ± 0.997.6 ± 0.895.4 ± 0.797.1 ± 0.8Observation group synthesis98.2 ± 0.899.9 ± 1.098.7 ± 0.999.8 ± 1.2Comprehensive evaluation t value8.4659.1528.8639.068Comprehensive evaluation p value0.0040.0070.0050.006In Table1, the bivariate selection range of T value and P value is the comprehensive results of the reference group and the observation group. Other single inspection methods are limited by the length and are not displayed.For the sensitivity of the more intuitive display test method, the data is now visualized, as shown in Figure2:Figure 2
visual diagram of inspection method sensitivity.It can be clearly seen from Figure2 that under the two different states of phase I/I-II and phase II, under the examination of electronic gastroscopy, ect and PET-CT, the image results of PET-CT are the most obvious, that is, the sensitivity to the lesion is the highest. This shows that PET-CT image examination can detect that when the disease is in the stage of molecular level change in the early stage, the morphology and structure of the lesion area have not been abnormal or obviously abnormal, and other image examinations can not make a clear diagnosis, PET examination can find the lesion, obtain three-dimensional images, and conduct quantitative analysis to achieve early diagnosis, This is unmatched by other imaging examinations.


### 3.2. Comparison of Prognosis Observation Results of Patients

Comparison of patient outcomes and quality of life observations by different examination methods are shown in Table2:Table 2
Comparison of observation results of prognosis and quality of life of different examination methods.
GroupingBy stagesnOne year survival rateOne year recurrence rateLymphatic metastasis rateHematogenous metastasis rateObservation groupI5249(94.2)5(9.6)4(7.7)5(9.6)I-II4440(90.9)6(13.6)5(11.4)6(13.6)II3823(60.5)12(31.6)14(36.8)13(34.2)Reference groupI5344(83.0)12(22.6)10(18.9)13(29.5)I-II4338(88.4)8(18.6)6(14.0)9(20.9)II3819(50.0)18(47.4)16(42.1)15(39.5)I t value9.2652.4612.0132.541I P value0.0080.0030.0020.004I-II T value8.8527.2656.9547.015I-II p value0.0080.0040.0030.005II t value8.1547.8543.0154.251II p value0.0090.0060.0040.007To more intuitively visualize the prognostic quality of survival observations of the different inspection methods, the data in Table2 are now visualized。The specific performance is shown below in Figures 3–6:Figure 3
Comparison of one-year survival rate under different grouping and staging conditions.Figure 4
Comparison of one-year recurrence rate under different grouping and staging conditions.Figure 5
Comparison of lymphatic metastasis rate under different groups and stages.Figure 6
Comparison of hematogenous metastasis rate under different grouping and staging conditions.In Figure3, the one-year survival rate is different under different examination methods, and the number of gastric cancer stages in three different states is set at the same time. The one-year survival rate is the largest under the intervention of PET-CT, which shows that the use of PET imaging can prolong the life length of patients.In Figure4, the one-year recurrence rate of patients under different examination methods is different. As in Figure 2, the number of gastric cancer stages under three different states is set. It is found that under different examination methods, the one-year recurrence rate of patients after PET-CT intervention is the lowest. This group of data also shows that PET imaging can effectively treat gastric cancer.In Figure5,It is similar to Figures 3 and 4, except that the variable is replaced by the lymphatic metastasis rate. Under different examination methods, the lymphatic metastasis rate of PET imaging is the lowest, which also shows the advantages of PET imaging in the scope of tumor treatment.Figure6 shows the comparison of blood metastasis rates under different imaging methods under different grouping and staging conditions. This group of charts also shows that the blood metastasis rate under PET imaging is the lowest, which also shows that PET imaging technology can be widely used in medical examination.


## 3.1. Comparison of Sensitivity and Specificity

Comparison of the sensitivity and specificity of the different inspection methods are shown in Table1:Table 1
Comparison of sensitivity and specificity of different examination methods.
Examination methods \ course and stageSensitivitySpecificityPhase I/I-IIPhase IIPhase I/I-IIPhase IIElectronic gastroscope78.6 ± 0.680.6 ± 0.579.3 ± 0.681.4 ± 0.6ECT92.3 ± 0.994.5 ± 0.893.6 ± 0.795.3 ± 0.6PET-CT96.9 ± 0.898.4 ± 0.797.1 ± 0.898.9 ± 0.8Reference group synthesis96.3 ± 0.997.6 ± 0.895.4 ± 0.797.1 ± 0.8Observation group synthesis98.2 ± 0.899.9 ± 1.098.7 ± 0.999.8 ± 1.2Comprehensive evaluation t value8.4659.1528.8639.068Comprehensive evaluation p value0.0040.0070.0050.006In Table1, the bivariate selection range of T value and P value is the comprehensive results of the reference group and the observation group. Other single inspection methods are limited by the length and are not displayed.For the sensitivity of the more intuitive display test method, the data is now visualized, as shown in Figure2:Figure 2
visual diagram of inspection method sensitivity.It can be clearly seen from Figure2 that under the two different states of phase I/I-II and phase II, under the examination of electronic gastroscopy, ect and PET-CT, the image results of PET-CT are the most obvious, that is, the sensitivity to the lesion is the highest. This shows that PET-CT image examination can detect that when the disease is in the stage of molecular level change in the early stage, the morphology and structure of the lesion area have not been abnormal or obviously abnormal, and other image examinations can not make a clear diagnosis, PET examination can find the lesion, obtain three-dimensional images, and conduct quantitative analysis to achieve early diagnosis, This is unmatched by other imaging examinations.


## 3.2. Comparison of Prognosis Observation Results of Patients

Comparison of patient outcomes and quality of life observations by different examination methods are shown in Table2:Table 2
Comparison of observation results of prognosis and quality of life of different examination methods.
GroupingBy stagesnOne year survival rateOne year recurrence rateLymphatic metastasis rateHematogenous metastasis rateObservation groupI5249(94.2)5(9.6)4(7.7)5(9.6)I-II4440(90.9)6(13.6)5(11.4)6(13.6)II3823(60.5)12(31.6)14(36.8)13(34.2)Reference groupI5344(83.0)12(22.6)10(18.9)13(29.5)I-II4338(88.4)8(18.6)6(14.0)9(20.9)II3819(50.0)18(47.4)16(42.1)15(39.5)I t value9.2652.4612.0132.541I P value0.0080.0030.0020.004I-II T value8.8527.2656.9547.015I-II p value0.0080.0040.0030.005II t value8.1547.8543.0154.251II p value0.0090.0060.0040.007To more intuitively visualize the prognostic quality of survival observations of the different inspection methods, the data in Table2 are now visualized。The specific performance is shown below in Figures 3–6:Figure 3
Comparison of one-year survival rate under different grouping and staging conditions.Figure 4
Comparison of one-year recurrence rate under different grouping and staging conditions.Figure 5
Comparison of lymphatic metastasis rate under different groups and stages.Figure 6
Comparison of hematogenous metastasis rate under different grouping and staging conditions.In Figure3, the one-year survival rate is different under different examination methods, and the number of gastric cancer stages in three different states is set at the same time. The one-year survival rate is the largest under the intervention of PET-CT, which shows that the use of PET imaging can prolong the life length of patients.In Figure4, the one-year recurrence rate of patients under different examination methods is different. As in Figure 2, the number of gastric cancer stages under three different states is set. It is found that under different examination methods, the one-year recurrence rate of patients after PET-CT intervention is the lowest. This group of data also shows that PET imaging can effectively treat gastric cancer.In Figure5,It is similar to Figures 3 and 4, except that the variable is replaced by the lymphatic metastasis rate. Under different examination methods, the lymphatic metastasis rate of PET imaging is the lowest, which also shows the advantages of PET imaging in the scope of tumor treatment.Figure6 shows the comparison of blood metastasis rates under different imaging methods under different grouping and staging conditions. This group of charts also shows that the blood metastasis rate under PET imaging is the lowest, which also shows that PET imaging technology can be widely used in medical examination.


## 4. Discussion

### 4.1. Ethical Demonstration of Clinical Trials

Both groups were treated with radical gastrectomy combined with chemotherapy. The treatment plan, medication principle and nursing path are completely consistent. The early (reference group) diagnosis and treatment system was legal and compliant. In addition to the different intervention measures, other important aspects were consistent between the groups. The details and contents of all trials respect the patient’s informed consent and decide whether to participate in the trial independently, and ensure that the patients will not be hurt. Moreover, the animal experiment of the new technology has been fully verified, and the safety experiment of the new technology has been carried out through medical experiments, mice and rabbits, which can show that it is safe enough for the clinical trial, can carry out the clinical trial, and will not cause any harm to the patients participating in the clinical trial [15–18]. The above-mentioned clinical trial was evaluated and approved by the medical ethics committee. The ethics committee has reviewed the scientificity and ethical rationality of the clinical trial project under the premise of national laws, regulations and relevant regulations, and guaranteed to respect the dignity, safety and rights of the subjects.


### 4.2. Significance of PET-CT in Early Gastric Mucosal Adenocarcinoma

One of the reasons for the high death rate of cancer is that it is found too late. If it can be found and treated early, the survival rate of patients will be greatly improved. However, the current examination technology may be in the stage of molecular level change in the early stage of cancer. When the morphological state change and structural variation of the lesion area are not obvious, the examination results can not be clearly displayed and can not be clearly diagnosed. However, PET-CT examination can find the disease of early cancer and obtain three-dimensional images for doctors’ reference and quantitative analysis, Achieve early diagnosis and treatment. Moreover, the specificity of PET-CT is also very high. When tumors are found by electronic gastroscopy and etc, it is difficult to judge the nature of the tumor and can not determine whether it is benign or malignant, but PET-CT can make diagnosis through the characteristics of high metabolism of malignant tumors. Another point is that PET-CT is relatively safe. Although the radionuclides required for its examination are radioactive, the amount of ethical radionuclides required is very small, and the half-life of the radionuclides used is very short [19, 20]. The radionuclides will have a limited retention time in the subject’s body due to the combined action of biological metabolism and physical attenuation, and will have no harmful effects on the human body. Yoon Seok Hwan; The investigation of acquisition time for harmony of image quality between PET/CT and PET/MRI systems: a phantom study by Park Chan ROK also looks at the technical differences between positron emission tomography (PET) systems, PET/CT, and PET/magnetic resonance imaging (MRI), which is crucial for the same diagnostic performance in terms of acquisition time and image quality.


## 4.1. Ethical Demonstration of Clinical Trials

Both groups were treated with radical gastrectomy combined with chemotherapy. The treatment plan, medication principle and nursing path are completely consistent. The early (reference group) diagnosis and treatment system was legal and compliant. In addition to the different intervention measures, other important aspects were consistent between the groups. The details and contents of all trials respect the patient’s informed consent and decide whether to participate in the trial independently, and ensure that the patients will not be hurt. Moreover, the animal experiment of the new technology has been fully verified, and the safety experiment of the new technology has been carried out through medical experiments, mice and rabbits, which can show that it is safe enough for the clinical trial, can carry out the clinical trial, and will not cause any harm to the patients participating in the clinical trial [15–18]. The above-mentioned clinical trial was evaluated and approved by the medical ethics committee. The ethics committee has reviewed the scientificity and ethical rationality of the clinical trial project under the premise of national laws, regulations and relevant regulations, and guaranteed to respect the dignity, safety and rights of the subjects.


## 4.2. Significance of PET-CT in Early Gastric Mucosal Adenocarcinoma

One of the reasons for the high death rate of cancer is that it is found too late. If it can be found and treated early, the survival rate of patients will be greatly improved. However, the current examination technology may be in the stage of molecular level change in the early stage of cancer. When the morphological state change and structural variation of the lesion area are not obvious, the examination results can not be clearly displayed and can not be clearly diagnosed. However, PET-CT examination can find the disease of early cancer and obtain three-dimensional images for doctors’ reference and quantitative analysis, Achieve early diagnosis and treatment. Moreover, the specificity of PET-CT is also very high. When tumors are found by electronic gastroscopy and etc, it is difficult to judge the nature of the tumor and can not determine whether it is benign or malignant, but PET-CT can make diagnosis through the characteristics of high metabolism of malignant tumors. Another point is that PET-CT is relatively safe. Although the radionuclides required for its examination are radioactive, the amount of ethical radionuclides required is very small, and the half-life of the radionuclides used is very short [19, 20]. The radionuclides will have a limited retention time in the subject’s body due to the combined action of biological metabolism and physical attenuation, and will have no harmful effects on the human body. Yoon Seok Hwan; The investigation of acquisition time for harmony of image quality between PET/CT and PET/MRI systems: a phantom study by Park Chan ROK also looks at the technical differences between positron emission tomography (PET) systems, PET/CT, and PET/magnetic resonance imaging (MRI), which is crucial for the same diagnostic performance in terms of acquisition time and image quality.


## 5. Summary

The clinical experiment approach is used in this investigation. The observation group and the reference group are the two groups of participants that are utilised. Different imaging modalities are used to verify the advantages and downsides of PET-CT. When the parameters of one-year survival rate, one-year recurrence rate, lymphatic metastasis rate, and blood metastasis rate of experimental subjects under the same grouping and staging conditions are compared, it is discovered that PET-CT examination results are more accurate and precise than current imaging methods.technique for examination Its widespread use will play a crucial role in medicine, lowering the survival rate of cancer patients significantly. PET-CT imaging technology, on the other hand, has many of the advantages listed above, but the doctors who perform the examination must have extensive experience, particularly in terms of the examination position and the number of nuclides injected for patients with various body shapes and diagnostic needs. Furthermore, the clinicians who read the film may need to be fluent in both radiology and nuclear medicine. Another consideration is that the present usage of PET-CT is costly.I’m concerned it will be tough for regular people to accept it and promoting it will be challenging. As a result, the follow-up will look at ways to lower the cost of examinations and make PET-CT examinations a widespread medical imaging examination technique.



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