Prediction of Occult Lymph Node Metastasis by Metabolic Parameters in Patients with Clinically N0 Esophageal Squamous Cell Carcinoma

Abstract

The aim of this study was to investigate the value of 18 F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. Methods: The study comprised 143 consecutive patients (mean age ± SD, 63.9 ± 8.6 y; range, 31.8-81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, 18 F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUV max ), mean SUV (SUV mean ), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. Results: Univariate analysis indicated that clinical T classification, SUV max , SUV mean , MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2-4, SUV max ≥ 4.8, SUV mean ≥ 3.2, MTV ≥ 5.5 cm 3 , TLG ≥ 220, and diameter ≥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7-12.4; P 5 0.003) and SUV max (HR, 3.5; 95% CI, 1.3-9.2; P 5 0.012) were independent risk factors. The combination of SUV max and clinical T classification (HR, 13.2; 95% CI, 5.4-31.9; P , 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUV max or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV max were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. Conclusion: SUV max , combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus. The accurate detection of regional lymph node metastasis in esophageal cancer is important for the selection of the proper treatment strategy. The presence of regional lymph node metastasis is particularly critical when making decisions about treatment, especially when tumor invasion is limited to submucosa of the esophagus. Current evaluation methods for preoperative tumor classification include multiimaging modalities such as CT, endoscopic ultrasonography (EUS), and 18 F-FDG PET/CT (1). However, current imaging modalities have limited capabilities, and diagnostic performance for the detection of regional lymph node metastases is incomplete (2). Despite comprehensive assessment using multiimaging modalities, a considerable percentage of patients with clinically N0 esophageal cancer are found to have regional lymph node metastasis after esophagectomy. The prevalence rate of occult lymph node metastasis ranges from 11% to 56% (3).18 F-FDG PET/CT has an advantage over conventional imaging modalities in that it provides quantitative i...

Predictive Value of 18F-FDG PET/CT for Axillary Lymph Node Metastasis in Invasive Ductal Breast Cancer

“…[6][7][8][9] Several studies have shown that metabolic activity of primary tumor on 18 F-FDG PET/CT can predict lymph node (LN) metastasis in various cancers. [10][11][12][13][14][15] However, breast cancer is a remarkably heterogeneous disease consisting of biologically distinct tumor subtypes. Many previous studies have shown a good correlation between 18 F-FDG uptake by primary tumor and molecular subtypes of breast cancer.…”

Diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for preoperative lymph node metastasis of esophageal cancer

“…[26] Studies have shown that N staging and the numbers of distant lymph node metastasis have important prognostic implications in patients with EC and are reliable prognostic factors for surgical treatment. [24,27,28] Therefore, the lymph node status has important significance for guiding treatment. At present, PET/CT that contains more detailed anatomical information and tissue metabolic information than traditional methods of examination has become essential for the assessment of lymph node metastasis in patients with EC.…”

“…At present, PET/CT that contains more detailed anatomical information and tissue metabolic information than traditional methods of examination has become essential for the assessment of lymph node metastasis in patients with EC. [20,24]…”

Esophageal cancer N staging study with endoscopic ultrasonography

“…A previous study suggested that a combination of multiple indexes (including size, shape and smooth edge) may improve the diagnostic accuracy of lymph node metastasis (20). Lymph nodes adjacent to a tumor are more likely to be affected (21); therefore in the present study, lymph nodes located near cancerous tissue were used as a marker of lymph node metastasis.…”