RT Journal Article
SR Electronic
T1 Diagnostic Accuracy of Lymph Node Metastasis Depends on Metabolic Activity of the Primary Lesion in Thoracic Squamous Esophageal Cancer
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 670
OP 676
DO 10.2967/jnumed.112.110304
VO 54
IS 5
A1 Osamu Manabe
A1 Naoya Hattori
A1 Kenji Hirata
A1 Kazuo Itoh
A1 Masao Hosokawa
A1 Hiroaki Takahashi
A1 Noriko Oyama-Manabe
A1 Nagara Tamaki
YR 2013
UL http://jnm.snmjournals.org/content/54/5/670.abstract
AB The metabolic activity of the primary tumor is an important variable in 18F-FDG PET interpretation for presurgical staging, because this activity is likely to affect the possibility of detection of malignant involvement in lymph nodes (LNs). The purpose of this study was to reevaluate the diagnostic accuracy of 18F-FDG PET/CT for the presurgical staging of esophageal squamous cell carcinoma (SCC) in correlation with the 18F-FDG avidity of the primary lesions. Methods: One hundred fifty-six patients (mean age ± SD, 61.4 ± 8.0 y) underwent 18F-FDG PET/CT before surgical esophagectomy and LN dissection. LN metastasis was identified using the fusion of PET and CT images with increased 18F-FDG uptake greater than the background activity of the adjacent structures. The results of the patients’ 18F-FDG PET/CT examinations for LN involvement were compared with the histopathologic results to investigate the diagnostic accuracy of 18F-FDG PET/CT for tumor staging. In addition, we examined the correlation between the diagnostic accuracy of 18F-FDG PET/CT for LN involvement and the 18F-FDG avidity of the primary lesions, to investigate the effect of tumor aggressiveness on the diagnosis of LN metastasis. Results: The diagnostic accuracy of 18F-FDG PET/CT for LN metastasis showed a low sensitivity, ranging from 29.3% to 53.3%, whereas the specificity was higher than 89.8% in regional thoracic nodes and in remote areas of the cervical and abdominal regions. The 18F-FDG uptake of the primary lesions positively correlated with that of the metastatic LNs in the thoracic field (R = 0.52, P < 0.05). As a result, our receiver-operating-characteristic analyses demonstrated an area under the curve value of 0.73, with the optimal cutoff value at a maximum standardized uptake value of 3.3 in patients with mid to high 18F-FDG avidity in the primary lesions (maximum standardized uptake value ≥ 5). Conclusion: This study showed that the avidity of the primary esophageal SCCs affected the detectability of lymph nodal metastases. If primary lesions of esophageal SCC present with a low 18F-FDG uptake, PET/CT may have a limited role for initial staging because of low sensitivity to detect lymph node metastases.