The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer

Abstract

Abstract. The purpose of the present study was to assess the contribution of simultaneous functional/anatomical imaging using integrated 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), compared with PET alone for the evaluation of initial lymph node staging in esophageal cancer. We studied 167 consecutive patients with thoracic esophageal squamous cell carcinoma (SCC) who had radical esophagectomy performed between January 1999 and April 2007. For individual nodal group evaluation, PET/CT showed 46.0% sensitivity (p<0.05 vs. PET), 99.4% specificity, 95.1% accuracy (p<0.05 vs. PET), 87.0% positive and 95.5% negative predictive values. PET showed 32.9% sensitivity, 98.9% specificity, 93.1% accuracy, 74.7% positive predictive value and 93.9% negative predictive value. Thus, the sensitivity and accuracy of PET/CT were significantly higher than those of PET. Comparisons between CT, PET and PET/CT in detecting lymph node metastasis by each region showed that PET/CT had a higher sensitivity in lower thoracic regions than PET and CT (p<0.05 vs. CT and PET). Lymph node staging (N0 vs. N1) was not significantly different, but staging per lymph nodal group was significantly better with PET/CT. Integrated PET/CT imaging with co-registration of anatomic and functional imaging data is useful in the initial lymph node staging of patients with operable esophageal cancer compared with PET alone.

Vascular endothelial growth factor C and D expression correlates with lymph node metastasis and poor prognosis in patients with resected esophageal cancer

“…The overall 5-year survival rate of patients with lymph node metastasis after surgical resection is only about 20% [22], and most of these patients die from tumor recurrence [23]. Despite new imaging techniques like computed tomography (CT) and positron emission tomography (PET), the sensitivity and specificity of clinical evaluation of lymph node involvement remains unsatisfactory [24].…”

The Efficacy of FDG-PET for the Management of Esophageal Cancer: Review Article

“…Kato et al proved that the diagnostic precision of FDG-PET for diagnosing lymph node metastases is superior to that of CT ( Table 1). 35) …”

Maximum standardized uptake value in 18F-fluoro-2-deoxyglucose positron emission tomography is associated with advanced tumor factors in esophageal cancer

“…The current TNM classification for esophageal cancer is based only on anatomical factors as compared to functional factors such as FDG uptake (15). However, mounting evidence suggests that functional factors are involved in tumor progression and prognosis, although possibly not to a greater extent than anatomical factors in esophageal cancer (3)(4)(5)(6)(7)(8)(9)(10). Non-invasive FDG-PET/CT may aid in the detection of not only anatomical, but also some genetic, oncological, molecular and biological factors.…”

“…A precise evaluation of the prognosis or overall survival (OS) of patients with esophageal cancer is essential for selecting appropriate treatment. Positron emission tomography/computed tomography (PET/CT) has become established in cancer imaging, and is useful for stratification during the primary staging of esophageal cancer by anatomical factors, such as tumor depth, invasion, lymph node metastasis and distant metastasis (3)(4)(5)(6)(7)(8)(9)(10). However, 18 F-fluoro-2-deoxyglucose (FDG)-PET may be used to evaluate functional factors associated with tumor activity, which depends on glucose metabolism.…”