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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2015; 21(37): 10502-10509
Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10502
Modern imaging techniques for preoperative detection of distant metastases in gastric cancer
Robert M Kwee, Thomas C Kwee
Robert M Kwee, Department of Radiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
Thomas C Kwee, Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Author contributions: Kwee RM and Kwee TC contributed equally to this work; Kwee RM and Kwee TC analyzed the data and wrote the paper.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
Open-Access: 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/
Correspondence to: Robert M Kwee, MD, PhD, Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. rmkwee@gmail.com
Telephone: +31-43-3874910 Fax: +31-43-3876909
Received: February 27, 2015
Peer-review started: February 27, 2015
First decision: April 14, 2015
Revised: April 20, 2015
Accepted: August 25, 2015
Article in press: August 25, 2015
Published online: October 7, 2015
Abstract

A substantial portion of patients with newly diagnosed gastric cancer has distant metastases (M1 disease). These patients have a very poor prognosis and it is generally accepted that they should be treated with noncurative intent. Because it dramatically changes prognosis and treatment plans, it is very important to diagnose distant metastases. In this article, the definition, pathways, incidence and sites of distant metastases in gastric cancer are described. Subsequently, the current performance of imaging in detecting distant metastases in newly diagnosed gastric cancer is outlined and future prospects are discussed.

Keywords: Gastric cancer, Ultrasonography, Distant metastases, Metastatic disease, Imaging, Computed tomography, Positron emission tomography, Magnetic resonance imaging, Scintigraphy

Core tip: Computed tomography is currently the primary imaging modality for M staging. Evaluation of ascites by endoscopic ultrasonography is useful because it has a high probability for the presence of peritoneal metastases. Staging laparoscopy is still necessary in patients with locally advanced disease with no definite evidence of peritoneal metastases at imaging. The roles of 18F-fluoro-2-deoxy-D-glucose positron emission tomography and magnetic resonance imaging need to be further explored. New imaging techniques and strategies are needed to improve M staging.