The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma

Abstract

BACKGROUNDThe purpose of the current study was to assess whether [18F]fluorodeoxyglucose positron emission tomography (FDG‐PET) provides incremental value (e.g., additional information on lymph node involvement or the presence of distant metastases) compared with computed tomography (CT) in patients with esophageal carcinoma.METHODSThe authors examined 149 consecutive patients with thoracic esophageal carcinoma. Eighty‐one patients underwent radical esophagectomy without pretreatment, 17 received chemoradiotherapy followed by surgery, 3 underwent endoscopic mucosal resection, and the remaining 48 patients received definitive radiotherapy and chemotherapy. The diagnostic accuracy of FDG‐PET and CT was evaluated at the time of diagnosis.RESULTSThe primary tumor was visualized using FDG‐PET in 119 (80%) of 149 patients. Regarding lymph node metastases, FDG‐PET had 32% sensitivity, 99% specificity, and 93% accuracy for individual lymph node group evaluation and 55% sensitivity, 90% specificity, and 72% accuracy for lymph node staging evaluation. PET exhibited incremental value over CT with regard to lymph node status in 14 of 98 patients who received surgery: 6 patients with negative CT findings were eventually shown to have lymph node metastases (i.e., they had positive PET findings and a positive reference standard [RS]); 6 patients with positive CT findings were shown not to have lymph node metastases (i.e., they had negative PET findings and a negative RS); and 2 patients were shown to have cervical lymph node metastases in addition to mediastinal or abdominal lymph node metastases. Among the remaining patients, PET showed incremental value over CT with regard to distant organ metastases in six patients. The overall incremental value of PET compared with CT with regard to staging accuracy was 14% (20 of 149 patients).CONCLUSIONSFDG‐PET provided incremental value over CT in the initial staging of esophageal carcinoma. At present, combined PET‐CT may be the most effective method available for the preoperative staging of esophageal tumors. Cancer 2005. © 2004 American Cancer Society.

The clinical application of 18F‐fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer

“…9 With regard to staging accuracy, the incremental diagnostic information provided by FDG-PET led to a change of staging in 14% of the patients with esophageal cancer, compared with conventional imaging. 19,20 Similar results have been reported by other groups. 5,6,8,19,21,22 In general, a change in International Union Against Cancer (UICC) stage occurs in approximately 20% of the patients with esophageal cancer using FDG-PET compared with conventional imaging modalities.…”

“…19,20 Similar results have been reported by other groups. 5,6,8,19,21,22 In general, a change in International Union Against Cancer (UICC) stage occurs in approximately 20% of the patients with esophageal cancer using FDG-PET compared with conventional imaging modalities. 23 Furthermore, changes in tumor metabolic activity during preoperative treatment have been shown to correlate with histopathologic response and patient survival.…”

“…All patients underwent curative thoracic esophagectomy that included the esophagogastric junction. 19 After surgery, the lymph nodes were separated from the resected esophagus and the adjacent tissue and were assigned specific numbers indicating the localization of the lymph node according to the guidelines of the Japanese Society for Esophageal Diseases. 39 The surgical specimens were fixed, embedded, stained with hematoxylin and eosin, and examined microscopically by 2 pathologists.…”

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

“…In the evaluation of disease stage in esophageal cancer patients, assessment of LN metastasis using positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is more accurate than CT (5)(6)(7). Recently, with the application of PET-CT to the disease stage evaluation in esophageal cancer patients, high sensitivity as well as specificity have been reported.…”

18F‐Fluorodeoxyglucose positron emission tomography can be used to determine the indication for endoscopic resection of superficial esophageal cancer

“…18 F‐Fluorodeoxyglucose positron emission tomography (FDG‐PET) is a useful imaging modality that reflects the tumor volume and activity 11, 12. Because of its limited spatial resolution, FDG‐PET has not been used for superficial cancer but has instead mainly been used for advanced cancer 13.…”