Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer

Okada, Masahiro; Murakami, Takamichi; Kumano, Seishi; Kuwabara, Masachika; Shimono, Taro; Hosono, Makoto; Shiozaki, Hitoshi

doi:10.1007/s12149-008-0209-1

Cited by 63 publications

(32 citation statements)

References 21 publications

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“…This value is higher than the previously reported mean SUVmax of metastatic LNs of esophageal SCC (25). We suspected that the higher prevalence of reactive inflammatory LNs in the thoracic field elevated the optimal cutoff criterion to separate the malignant versus inflammatory pathologies.…”

Section: Discussioncontrasting

confidence: 56%

Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer

et al. 2013

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The metabolic activity of the primary tumor is an important variable in 18 F-FDG PET interpretation for presurgical staging, because this activity is likely to affect the possibility of detection of malignant involvement in lymph nodes (LNs). The purpose of this study was to reevaluate the diagnostic accuracy of 18 F-FDG PET/CT for the presurgical staging of esophageal squamous cell carcinoma (SCC) in correlation with the 18 F-FDG avidity of the primary lesions. Methods: One hundred fifty-six patients (mean age 6 SD, 61.4 6 8.0 y) underwent 18 F-FDG PET/CT before surgical esophagectomy and LN dissection. LN metastasis was identified using the fusion of PET and CT images with increased 18 F-FDG uptake greater than the background activity of the adjacent structures. The results of the patients' 18 F-FDG PET/CT examinations for LN involvement were compared with the histopathologic results to investigate the diagnostic accuracy of 18 F-FDG PET/CT for tumor staging. In addition, we examined the correlation between the diagnostic accuracy of 18 F-FDG PET/CT for LN involvement and the 18 F-FDG avidity of the primary lesions, to investigate the effect of tumor aggressiveness on the diagnosis of LN metastasis. Results: The diagnostic accuracy of 18 F-FDG PET/CT for LN metastasis showed a low sensitivity, ranging from 29.3% to 53.3%, whereas the specificity was higher than 89.8% in regional thoracic nodes and in remote areas of the cervical and abdominal regions. The 18 F-FDG uptake of the primary lesions positively correlated with that of the metastatic LNs in the thoracic field (R 5 0.52, P , 0.05). As a result, our receiver-operatingcharacteristic analyses demonstrated an area under the curve value of 0.73, with the optimal cutoff value at a maximum standardized uptake value of 3.3 in patients with mid to high 18 F-FDG avidity in the primary lesions (maximum standardized uptake value $ 5). Conclusion: This study showed that the avidity of the primary esophageal SCCs affected the detectability of lymph nodal metastases. If primary lesions of esophageal SCC present with a low 18 F-FDG uptake, PET/CT may have a limited role for initial staging because of low sensitivity to detect lymph node metastases.

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Section: Discussioncontrasting

confidence: 56%

Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer

et al. 2013

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“…The recent use of PET/CT imaging with co-registration of anatomical and functional imaging data has improved the localisation of regions of increased FDG uptake and the accuracy of staging in patients with oesophageal cancer [15,16]. Okada et al [16] found that the sensitivity, specificity and accuracy of PET/CT for detecting metastatic regional lymph nodes were better than those of CT (60 vs 56%, 99.5 vs 97.3% and 94.8 vs 92.4%, respectively). In our study, however, PET/CT showed worse specificity and accuracy for detecting metastatic regional lymph nodes in patients with oesophageal cancer when compared with CT, despite a similar sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Hounsfield units upon PET/CT are useful in evaluating metastatic regional lymph nodes in patients with oesophageal squamous cell carcinoma

Lokesh²,

Ej³

et al. 2012

BJR

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Objectives: This study evaluated the usefulness of measurements of X-ray attenuation (in Hounsfield units) obtained from unenhanced CT images for attenuation correction of the positron emission tomography (PET) data from PET/CT in the assessment of regional lymph node metastasis in oesophageal squamous cell carcinoma. Methods: 17 patients with oesophageal squamous cell carcinoma underwent surgery after evaluation with PET/CT. After the excised lymph nodes were reviewed, we compared the histopathology and PET/CT findings, and analysed the lymph node metastasis. When 18-F fludeoxyglucose (FDG) uptake in the lymph nodes was focally prominent in comparison with background mediastinal activity (regardless of lymph node size), the lymph nodes were considered to be positive for malignancy by PET/CT. The mean Hounsfield units of mediastinal lymph nodes showing abnormally increased FDG uptake in PET/CT was retrospectively evaluated using images from the unenhanced CT component of PET/CT. Receiver operating characteristic (ROC) curve analysis was applied to determine the optimal cut-off value of mean Hounsfield units for detecting individual lymph node metastases. Results: For depiction of malignant nodal groups in each lymph node group, the sensitivity, specificity and accuracy of PET/CT based on increased FDG uptake were 58.8%, 74.5% and 70.8%, respectively. For patients with nodal groups that were positive for uptake by PET/CT, the mean attenuation in lymph nodes as measured by CT was 48¡13 HU for malignant nodes and 75¡18 HU for benign nodes. This difference was statistically significant (p,0.001). Using ROC curve analysis, we determined the cut-off as 71 HU. When we excluded lymph nodes with attenuation higher than 71 HU from the nodes determined as malignant by PET/CT, the specificity and accuracy for detecting metastatic lymph nodes improved to 90.9% and 83.3%, respectively. Conclusions: When interpreting lymph node metastasis in oesophageal squamous cell carcinoma using PET/CT, the assumption that any lymph node with mean HU.71 is benign can improve diagnostic accuracy.

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“…et al compared the enlargement of lymph node based on CT scanning with that diagnosed by pathological examination in 41 cases of esophageal cancers, proposing 5 mm as the diagnostic criteria of short diameter, the sensitivity and specificity of which were 68% and 87%, respectively (Mizowaki et al, 1996). Currently most investigators take 10 mm as the lower limit of lymph node metastasis, with the sensitivity and specificity of which are 11%~77% and 71%~97.3%, respectively (Yoon et al, 2003;Okada et al, 2009;Ma et al, 2013). The enhanced features of metastatic lymph nodes from different pathology of primary tumors showed different under MSCT scanning, usually displaying as ring-shaped and thin-wall enhancement.…”

Section: Discussionmentioning

confidence: 99%

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Tan

Yao²,

Huang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (18), 7719-7724 IntroductionEsophageal cancer is the ninth malignant tumor in death in the world. There is an average of 150, 000 people died of esophageal cancer every year and ranked forth in China. The 5-year survival rate is less than 10% for patients suffering from esophageal cancer, and showed poor prognosis. The reason may be due to that the majority of patients have been diagnosed as advanced when perceived, and full-thickness esophageal wall has been involved or lymph node metastasis and distant metastasis has occurred. Lymph node metastasis and metastatic numbers are believed as dependent negative AbstractBackground: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.

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Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer

Abstract: Integrated PET/CT improves the PPV of regional LNs when compared with CECT.

Cited by 63 publications

References 21 publications

Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer

Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer

Hounsfield units upon PET/CT are useful in evaluating metastatic regional lymph nodes in patients with oesophageal squamous cell carcinoma

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

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