Positron Emission Tomography-Computed Tomography in Predicting Locoregional Invasion in Esophageal Squamous Cell Carcinoma

Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
The Annals of thoracic surgery (Impact Factor: 3.65). 06/2009; 87(5):1564-8. DOI: 10.1016/j.athoracsur.2009.02.065
Source: PubMed

ABSTRACT In order to clarify the role of positron emission tomography-computed tomography (PET/CT) in thoracic esophageal squamous cell carcinoma we investigated its value in predicting locoregional invasion.
Forty-five patients receiving curative esophagectomy and lymph node dissection were included. The relationship between PET/CT findings and pathology results were studied. Correlation between nodal uptake and the modified lymph node staging, which is based on number of involved nodes (N0 = no nodes; N1 = 1 to 3 nodes; N2 = more than 3 nodes), was evaluated.
The mean maximal standardized uptake value (SUV(max)) was 5.09 +/- 4.00 in T1, 14.17 +/- 2.46 in T2, 13.32 +/- 3.96 in T3, and 10.37 +/- 1.94 in T4 primary tumor. The SUV(max) was significantly lower in stage T1 tumors than in stage T2 and T3 tumors. For regional nodal involvement, PET/CT findings significantly correlated with pathology results. However, the sensitivity, specificity, and accuracy of PET/CT were only 57.1%, 83.3%, and 71.1%, respectively, and even lower for detecting nonregional lymph node metastasis. When stratified by the modified staging system, the mean SUV(max) was 0.64 +/- 1.60 in N0, 1.43 +/- 2.08 in N1, and 4.67 +/- 4.32 in N2 regional lymph node metastases, and was significantly higher in patients with N2 metastasis than in patients with N0 and N1 metastases.
Locoregional invasion in esophageal cancer can be predicted by PET/CT. The SUV(max) of the primary tumor helped identify T1 tumor, and the SUV(max) of the regional lymph nodes correlated with the severity of nodal involvement.

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    ABSTRACT: Objective: In this study, we aimed to explore prognostic importance of definition of preoperative metabolic tumor volume in esophageal cancer patients. Methods: 22 patients who have histologically proven stage IIA-III esophageal cancer and underwent 18F-FDG PET/CT for preoperative staging of disease were included to the study. After 18F-FDG PET/CT, all the patients underwent surgery within 4 weeks period. Patients have been followed up until death or Sept 15th, 2012. Dates of death were recorded for survival analysis. During evaluation of 18F-FDG PET/CT images, metabolic tumor volumes were calculated by drawing the isocontour region of interests from all visually positive FGD uptake lesions. Results: 22 patients (15M, 7F; mean age: 65.1±8.4, min-max:48-80) underwent 18F-FDG PET/CT for preoperative staging of esophageal cancer. Preoperative diagnosis was squamous cell and adeno cancer in 17 (%77) and 5 (%23) patients, respectively. Location of primary tumor is distal, proximal and mid-esophagus in 13 (%59), 6 (%27) and 3 (%13) patients, respectively. Primary tumor of all the patients were FDG avid (mean SUVmax: 18.85±7.0; range: 5.5-35.1). Additionally, 18F-FDG uptake was seen in mediastinal lymph nodes in 13 patients (5.45±8.15; range: 2.6-29.9). Mean metabolic tumor volumes of primary esophageal lesions were calculated as 8.77±8.46cm3 (range: 2.3-34.2). Mean MTV of lymph nodes was 2.44±1.01cm3 (range: 0.4-3.6). Mean total metabolic tumor volume was calculated as 9.99±8.58cm3 (range: 2.3-27.3). 10 patients died during 447±121 days follow-up period. Mean survival time was 11.9±1.5 months (95%CI: 8.99-14.74) for entire patient group. Total metabolic tumor volume had a significant effect on survival (p=0.045) according to Cox proportional hazards regression analysis. One unit increase in MTV caused 1.1 (95%CI:1.003-1.196) fold increase in hazard, at any time. Conclusion: Definition of preoperative metabolic tumor volume has a prognostic value in the prediction of postoperative survival times. Patients who have higher preoperative metabolic tumor volumes could be good candidates for more aggressive chemo-radiation therapy regiments. Conflict of interest:None declared.
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    ABSTRACT: The aim of this study, was to investigate the relationship between (18)F-fluorodeoxyglucose ((18)F-FDG) uptake in primary tumors and the clinicopathological characteristics of esophageal squamous cell carcinoma (ESCC) patients. Patients with histopathologically diagnosed ESCC who had received a pre-therapeutic (18)F-FDG positron emission tomography-computed tomography (PET-CT) scan were enrolled in the study. The maximum standardized uptake value (SUVmax) and the length of the primary tumor were measured by PET-CT. The clinical tumor-node-metastasis (TNM) stage was determined mainly by PET-CT images according to the American Joint Committee on Cancer (AJCC) staging system, 2002. A significant difference was observed in SUVmax between the length and T stage of the primary tumor (P=0.000 and P=0.017, respectively), but not in the grade of tumor differentiation (P=0.383), clinical stage (P=0.583), N staging (P=0.387), M staging (P=0.886), patient age (P= 0.752) or gender (P=0.233). There was a significant positive correlation between the SUVmax and the length of the tumor (r=0.456, P=0.000) and the depth of invasion of the primary tumor (r=0.257, P=0.006). After controlling for length, no statistically significant correlation was found between T stage and SUVmax (r=0.074, P=0.537). In conclusion, these findings suggest that tumor length influences FDG uptake in ESCC tumors, and that the T stage of the primary tumor is not significantly correlated with the SUVmax after controlling for length. However, we did not find a significant correlation between the SUVmax and primary tumor differentiation and clinical stage. These data provide important information for the management of ESCC.
    Experimental and therapeutic medicine 01/2013; 5(1):170-174. DOI:10.3892/etm.2012.772 · 0.94 Impact Factor
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