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

Abstract

18F‐Fluorodeoxyglucose positron emission tomography (FDG‐PET) is a useful imaging modality that reflects the tumor activity. However, FDG‐PET is mainly used for advanced cancer, not superficial cancer. In this study, we investigated the relationship between the superficial tumor depth of esophageal cancer and the FDG uptake to determine the indications for endoscopic resection (ER). From 2009 to 2017, 444 patients with esophageal cancer underwent esophagectomy or endoscopic submucosal dissection (ESD), and 195 patients were pathologically diagnosed with superficial cancer. Among them, 146 patients were examined by FDG‐PET before esophagectomy or ESD. In these 146 patients, the relationship between the pathological tumor depth and FDG uptake was analyzed. The mean maximum standardized uptake value in pT1a‐EP/LPM tumors was 1.362 ± 0.890, that in pT1a‐MM/pT1b‐SM1 tumors was 2.453 ± 1.872, and that in pT1b‐SM2/SM3 tumors was 4.265 ± 3.233 (P < .0001). Among 51 pT1a‐EP/LPM tumors, 10 (19.6%) showed positive detection of FDG. For pT1a‐MM/pT1b‐SM1 and pT1b‐SM2/SM3 tumors, the detection rate was 52.9% (18/34) and 82.0% (50/61), respectively. The detection rate of pT1a‐EP/LPM was significantly lower than in the other two groups (P < .0001). Among 10 FDG‐PET‐positive lesions, only 1 had no apparent reason for PET positivity; however, 9 of 10 had a suitable reason for detectability by PET and inadequacy for ER. Negative detection of superficial esophageal squamous cell carcinoma by FDG‐PET is useful to determine the indication for ER when the tumor depth cannot be diagnosed even after performing magnifying endoscopy with narrow band imaging and endoscopic ultrasonography. When FDG uptake is recognized, a therapeutic modality other than ER should be considered.

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…In one of these reports, the sensitivity and accuracy of ME-NBI in distinguishing m1–m2 from m3 /sm1 and from more deeply invasive SCCs was significantly higher than that of EUS ( P = 0.048 and P = 0.017, respectively) 44 . Recent studies have emphasized the relevance of MRI and PET-CT with regard to T1 lesions, showing a high accuracy of MRI compared to EUS and CT 45 46 , and a possible role for PET-CT in identifying T1a lesions when no uptake can be seen in the esophageal wall 47 , but these studies need further validation. Nevertheless, since PET-CT is a standard staging method for advanced SCC, the combined use of PET-CT and high resolution CE, especially with microvascular findings of types B2 and B3, may be useful to determine whether ER is indicated for the lesion 48 .…”

“…Nevertheless, since PET-CT is a standard staging method for advanced SCC, the combined use of PET-CT and high resolution CE, especially with microvascular findings of types B2 and B3, may be useful to determine whether ER is indicated for the lesion [48]. When the lesion is visible on PET, a therapeutic modality other than ER should be considered [47].…”

Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG Uptake in Esophageal Cancer

“…Compared to [ 18 F]FDG, [ 68 Ga]Ga-DOTA-FAPI-04 shows several advantages, including equal or better tumor-to-background ratio, independence of blood glucose levels, rapid renal clearance, and feasibility of rapid image acquisition ( 12 , 13 ). [ 18 F]FDG PET has, instead, mainly been used for advanced cancer and is not indicative in staging superficial esophageal cancer due to spatial resolution limitations ( 14 ). This study has shown that [ 68 Ga]Ga-DOTA-FAPI-04 was able to visualize small tumors (diameter < 1.0 cm) which might be missed by the [ 18 F]FDG PET/CT ( 4 ).…”

Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma

“…Nakajima et al[17] took a closer look at the indications for ER of superficial ESCC. They investigated the relationship between tumor depth and FDG uptake in 146 superficial ESCCs before treatment, and they proposed a diagnostic algorithm for superficial ESCC.…”