Multidetector CT Assessment of Lymph Node Size for Nodal Staging in Patients with Potentially Operable Squamous Esophageal Cancer and the¹⁸F-FDG Positron Emission Tomography CT Correlation

Abstract

Purpose:To investigate the size criteria of multidetector computed tomography (MD-CT) for the evaluation metastatic lymph nodes (LNs) for potentially operable squamous esophageal cancer, and to compare this information with the results of positron emission tomography-CT (PET-CT). Materials and Methods: Twenty-four patients who underwent radical esophagectomy for esophageal cancer were studied. All patients had preoperative MDCT and PET-CT. The MDCT findings were compared with those of PET-CT and were correlated with the surgical records. The receiver operating characteristic (ROC) curve method was used to determine the appropriate cut-off value to distinguish benign from metastatic LNs. Results: The size of metastatic LNs (9.35 3.41 mm) was significantly larger than that of benign LNs (5.741.64 mm) (p<0.001). The best cut-off value was 7 mm (81.8% sensitivity, 80.8% specificity). PET-CT detected all metastatic LNs except for four in the peritumoral region. The sensitivity and specificity of metastatic LN evaluation on PET-CT were 82.6% and 99.4%, respectively. Only one LN without metastasis showed increased fluoro-2-deoxy-D-glucose uptake on PET-CT. Conclusion: Size of metastatic LNs can typically be < 10 mm. For MDCT, the short diameter of 7 mm may be the optimal criterion. PET-CT is very accurate for the assessment of metastatic LNs except for those in the peritumoral region.

Association between prognosis and lymph node status using 18F‐fluorodeoxyglucose‐positron emission tomography in esophageal squamous cell carcinoma treated with esophagectomy post‐neoadjuvant chemotherapy

“…This present study detailed the assessment of pathological LN metastasis using preoperative FDG‐PET LN status in patients with ESCC who underwent surgery post‐NCT and determined the association between preoperative FDG‐PET LN status and prognosis. LN status assessed using FDG‐PET significantly correlates with pathological LN metastasis in patients with esophageal cancer treated with surgery alone, neoadjuvant chemoradiotherapy (NCRT), and NCT 16–18,23–31 . A case‐by‐case analysis revealed that the sensitivity, specificity, and accuracy of FDG‐PET for LN status pre‐ and post‐NCT were 42.7%–45.9%, 90.3%–92.1%, and 62.6% , 16,18 similar to our results.…”

“…LN status assessed using FDG-PET significantly correlates with pathological LN metastasis in patients with esophageal cancer treated with surgery alone, neoadjuvant chemoradiotherapy (NCRT), and NCT . [16][17][18][23][24][25][26][27][28][29][30][31] A case-by-case analysis revealed that the sensitivity, specificity, and accuracy of FDG-PET for LN status pre-and post-NCT were 42.7%-45.9%, 90.3%-92.1%, and 62.6% , 16,18 similar to our results.…”

“…Station‐by‐station analyses revealed that the sensitivity, specificity, and accuracy of FDG‐PET were 25.8%–83.0%, 88.0%–98.9%, and 86.0%–94.8%, respectively, in surgery‐alone cases 23–29 . The sensitivity, specificity, and accuracy of FDG‐PET for LN status pre‐ and post‐NCRT were 12%–41.7%, 92.0%–99.4%, and 92.7%–95.6%, respectively, according to station‐by‐station analyses 30,31 .…”

“…Station-by-station analyses revealed that the sensitivity, specificity, and accuracy of FDG-PET were 25.8%-83.0%, 88.0%-98.9%, and 86.0%-94.8%, respectively, in surgery-alone cases . [23][24][25][26][27][28][29] The sensitivity, specificity, and accuracy of FDG-PET for LN status pre-and post-NCRT were 12%-41.7%, 92.0%-99.4%, and 92.7%-95.6%, respectively, according to station-by-station analyses . 30,31 No station-by-station analysis regarding the sensitivity, specificity, and accuracy of FDG-PET for LN status pre-and post-NCT has been reported, to date.…”