Clinical usefulness of<sup>18</sup>F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy

Sun, Long; X, Su; Guan, Yong-Song; Pan, Wei-Ming; Luo, Zun-Chang; Wei, Jihong; Zhao, Long; Wu, Hua

doi:10.3748/wjg.15.1836

Cited by 19 publications

(10 citation statements)

References 33 publications

(47 reference statements)

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“…The general characteristics of the included studies are presented in Table 2 (17)(18)(19)(20)(21)(22)(23)(24). Table 3 outlines the used 18 F-FDG PET or PET/CT parameters and reference standards.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Only 1 of the 8 studies was prospectively designed to answer this research question (22). The duration of clinical follow-up after acquisition of a 18 F-FDG PET or PET/CT scan was less than 6 mo in 1 of the included studies (23), at least 6 mo or longer in 5 studies (17,18,20,21,24), and not described in 2 other studies (19,22). In 4 studies, the diagnostic value of integrated 18 F-FDG PET/CT was analyzed (17,18,20,21), and 3 studies analyzed the diagnostic value of standalone 18 F-FDG PET (22)(23)(24).…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Studies examining the test accuracy of 18 F-FDG PET or integrated 18 F-FDG PET/CT, either in routine clinical follow-up with a fixed time interval irrespective of physical complaints or in symptomatic patients in whom recurrence of esophageal cancer was suspected, were deemed eligible for inclusion. Only studies that included patients who were previously treated with curative intent for esophageal cancer and that reported on the diagnostic accuracy of 18 F-FDG PET or PET/CT for the detection of disease recurrence were included.…”

Section: Study Selectionmentioning

confidence: 99%

“…Whole-body 18 F-FDG PET and integrated 18 F-FDG PET/CT have emerged as useful adjuncts to conventional staging modalities in the pretreatment staging of esophageal cancer. In particular, baseline 18 F-FDG PET/CT has gained ground by outperforming CT alone in the detection of unexpected distant metastases (11).…”

mentioning

confidence: 99%

“…In particular, baseline 18 F-FDG PET/CT has gained ground by outperforming CT alone in the detection of unexpected distant metastases (11). Accordingly, 18 F-FDG PET or PET/CT may also be a useful method for detecting recurrent disease in the postoperative follow-up of esophageal cancer patients because recurrences tend to occur predominantly at distant sites (7). In the past years, several studies have been published on the utility of 18 F-FDG PET or PET/CT in the detection of esophageal cancer recurrence.…”

mentioning

confidence: 99%

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Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis

et al. 2015

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The aim of this study was to assess the diagnostic performance of 18 F-FDG PET and integrated 18 F-FDG PET/CT for diagnosing recurrent esophageal cancer after initial treatment with curative intent. Methods: The PubMed, Embase, and Cochrane library were systematically searched for all relevant literature using the key words " 18 F-FDG PET" and "esophageal cancer" and synonyms. Studies examining the diagnostic value of 18 F-FDG PET or integrated 18 F-FDG PET/CT, either in routine clinical follow-up or in symptomatic patients in whom recurrence of esophageal cancer was suspected, were deemed eligible for inclusion. The primary outcome was the presence of recurrent esophageal cancer as determined by histopathologic biopsy or clinical follow-up. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Sensitivities and specificities of individual studies were meta-analyzed using bivariate randomeffects models. Results: Eight eligible studies were included for meta-analysis, comprising 486 patients with esophageal cancer who underwent 18 F-FDG PET or PET/CT after previous treatment with curative intent. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable; there were few concerns with regard to the risk of bias and applicability. Integrated 18 F-FDG PET/CT and standalone 18 F-FDG PET were used in 4 and 3 studies, respectively. One other study analyzed both modalities separately. In 4 studies, 18 F-FDG PET or PET/CT was performed as part of routine follow-up, whereas in 4 other studies the diagnostic test was performed on indication during clinical follow-up. Pooled estimates of sensitivity and specificity for 18 F-FDG PET and PET/CT in diagnosing recurrent esophageal cancer were 96% (95% confidence interval, 93%-97%) and 78% (95% confidence interval, 66%-86%), respectively. Subgroup analysis revealed no statistically significant difference in diagnostic accuracy according to type of PET scanner (standalone PET vs. integrated PET/CT) or indication of scanning (routine follow-up vs. on indication). Conclusion: 18 F-FDG PET and PET/CT are reliable imaging modalities with a high sensitivity and moderate specificity for detecting recurrent esophageal cancer after treatment with curative intent. The use of 18 F-FDG PET or PET/CT particularly allows for a minimal false-negative rate. However, histopathologic confirmation of 18 F-FDG PET-or PET/CTsuspected lesions remains required, because a considerable falsepositive rate is noticed.

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