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: 3.85). 06/2009; 87(5):1564-8. DOI: 10.1016/j.athoracsur.2009.02.065
Source: PubMed


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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    • "Prediction of disease prognosis and survival in preoperative period is crucial for consideration of more aggressive pre or postoperative adjuvant treatments in selected esophageal cancer patients (8). 18F-FDG PET/CT is a metabolic imaging method and its usefulness in esophageal cancer patients has been reported in several studies (9,10,11,12). SUV has been widely used parameter for evaluation of FDG uptake degree of several tumor types. However, because generally tumors have nonhomogeneous 18F-FDG uptake pattern, SUV could be a rough parameter in the evaluation of total lesion glucose metabolism. "
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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.
    Full-text · Article · Feb 2014
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    • "Tumor stage is used to describe the extent of disease and tumor aggressiveness, and is an important parameter for guiding treatment decisions and evaluating prognosis. A previous study showed that PET-CT was a valuable tool for primary staging of esophageal carcinoma (6) and that SUVmax could identify the extent of tumor infiltration and nodal involvement (20). Therefore, based on these previous findings, the clinical TNM stage of the tumors in our study was determined mainly by PET-CT scans in combination with contrast CT and other imaging methods. "
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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.
    Full-text · Article · Jan 2013 · Experimental and therapeutic medicine
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    • "For loco-regional lymph node involvement, many studies reported that sensitivity varied, ranging from 22% and 72% [2] [29] [30]. In a retrospective study, Hsu et al. [27] reported sensitivities and specificities rates for regional lymph node involvement of, 57.1% and 83.3%, respectively. In comparison, our data demonstrate that the combination of early SUV max 2.5 or RI 10% produced a sensitivity of 70% and specificity of 56.3%. "
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    ABSTRACT: We conducted this study to investigate the value of the dual-time 2-[(18)F]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography-computed tomography (PET-CT) in assessment of the primary tumor, loco-regional lymph node and distant metastasis in patients with esophageal squamous cell carcinoma. Twenty-six patients with histologically proved esophageal squamous cell carcinoma underwent dual-time FDG PET-CT before radical surgery. The standardized uptake values (SUV(max)) were obtained including early SUV(max) and delayed SUV(max), respectively. The retention index (RI) was also calculated. The results were evaluated retrospectively according to the final pathologic findings. Four diagnostic criteria including (1) early SUV(max)≧ 2.5 alone, (2) RI ≧ 10% alone, (3) a combination of early SUV(max)≧ 2.5 and RI ≧ 10%, and (4) a combination of early SUV(max)≧ 2.5 or RI ≧ 10% were used for differentiating malignancy from a benign lesion, respectively. The sensitivity of FDG PET-CT in detecting the primary tumor with combination of early SUV(max)≧ 2.5 or RI ≧ 10% was 96.2%. It was statistically significantly higher than the results using the other three criteria (p<0.0001). For loco-regional lymph node detection, there was no significant difference among the 4 criteria. For distal metastases, the significantly higher specificity (100%) was found when using combination of early SUV(max)≧ 2.5 and RI ≧ 10% or using early SUV(max)≧ 2.5 alone than using the other two criteria (p=0.0058). With regard to accuracy, no significant correlations were observed among primary tumor, loco-regional lymph nodes and distant metastasis (p>0.05). The preliminary result of this study demonstrated that dual-time point FDG PET-CT had limited value in detection of primary tumor and loco-regional lymph nodes metastasis. For the distant metastasis, the sensitivity and specificity would be improved if RI ≧ 10% is used as a supplemental criterion. Efforts should be made to improve the ability of the dual-time FDG PET-CT technique to assess primary tumor and loco-regional lymph nodes metastasis.
    Full-text · Article · Mar 2011 · European journal of radiology
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