Research ArticleClinical Investigations

Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer

Osamu Manabe, Naoya Hattori, Kenji Hirata, Kazuo Itoh, Masao Hosokawa, Hiroaki Takahashi, Noriko Oyama-Manabe and Nagara Tamaki
Journal of Nuclear Medicine May 2013, 54 (5) 670-676; DOI: https://doi.org/10.2967/jnumed.112.110304

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    SUVmax of primary lesions among different pT stages.

  • FIGURE 2.
    FIGURE 2.

    Representative 18F-FDG PET images of 52-y-old man with SCC of upper thoracic esophagus showing high 18F-FDG avidity in primary lesion. (A) Whole-body maximum-intensity-projection image demonstrating high 18F-FDG avidity in primary lesion (blue arrow; SUVmax, 24.8) and LN uptake in the cervical and thoracic regions (black arrows). (B) Axial image of cervical region showing abnormal 18F-FDG uptake in metastatic LN (SUVmax, 9.7). (C) Axial image of upper thoracic region showing abnormal 18F-FDG uptake in metastatic LN (SUVmax, 9.7). Pathologic analyses disclosed T3, LN metastasis of cervical and thoracic regions, which were concordant with 18F-FDG PET/CT findings.

  • FIGURE 3.
    FIGURE 3.

    Representative SUVmax of regional and remote LN metastases was plotted against SUVmax of primary lesions. Representative value of LN SUVmax was defined as highest SUVmax of metastatic LNs in each region (cervical, thoracic, and abdominal).

  • FIGURE 4.
    FIGURE 4.

    Comparison of sensitivities with visual analysis among different 18F-FDG avidity in primary lesions.

  • FIGURE 5.
    FIGURE 5.

    Results of ROC analyses: all patients (A), patients with low 18F-FDG avidity in primary lesions (SUVmax < 5) (B), and patients with mid to high 18F-FDG avidity in primary lesions (SUVmax ≥ 5) (C).

Tables

  • TABLE 1

    Sensitivity of Primary Lesions

    pT stage18F-FDG positiveTotalSensitivity (%)
    T1a101662.5
    T1b425773.7
    T21212100
    T36969100
    T422100
    Total13515686.5
  • TABLE 2

    18F-FDG PET/CT and Pathologic Findings of LN Metastasis

    N stagePETPathology
    N010067
    N15046
    N2623
    N3020
  • TABLE 3

    Pathologic N Stages Among Each Avidity Group of Main Lesion

    Avidity
    N stageLow (SUVmax < 5)Mid (5 ≤ SUVmax < 10)High (10 < SUVmax)
    N035 (60.3)15 (36.6)17 (29.8)
    N115 (25.9)10 (24.4)21 (36.8)
    N26 (10.3)9 (22.0)8 (14.0)
    N32 (3.4)7 (17.1)11 (19.3)
    Total584157

    • Data in parentheses are percentages.

  • TABLE 4

    Diagnostic Value of Nodal Involvements by Activity of Main Lesion

    All nodesRegional nodesRemote nodes
    ParameterLowMid to highLowMid to highLowMid to high
    Sensitivity (%)15.241.515.433.715.046.9
    Specificity (%)95.792.391.189.697.993.5
    Positive predictive value (%)45.576.333.374.060.078.3
    Negative predictive value (%)82.871.378.861.684.776.4

    • Low = SUVmax < 5; mid to high = SUVmax ≥ 5.

  • TABLE 5

    Diagnostic Value of LN Metastasis Using Best-Cutoff Criteria in Mid to High Avidity in Primary Lesions

    ParameterAll (n = 73)Regional (n = 26)Remote (n = 47)
    Sensitivity (%)66.170.064.1
    Specificity (%)85.766.7100.0
    Positive predictive value (%)95.187.5100.0
    Negative predictive value (%)37.540.036.4

    • Best-cutoff criteria (SUVmax, 3.3) was determined from all nodes and then applied to both regional and remote groups.

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