RT Journal Article
SR Electronic
T1 Role of 18F FDG PET CT in restaging of oesophageal cancer after curative surgical resection
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 494
OP 494
VO 58
IS supplement 1
A1 SHANTANU Pande
A1 SAYAK Choudhury
A1 AMEYA Puranik
A1 Sneha Shah
A1 Archi Agrawal
A1 Nilendu Purandare
A1 Venkatesh Rangarajan
YR 2017
UL http://jnm.snmjournals.org/content/58/supplement_1/494.abstract
AB 494Objectives: The aim of study was to evaluate diagnostic performance of FDG PET-CT in oesophageal cancer with suspected recurrence after curative surgical resection and impact of FDG PET-CT on intended management.Methods: This study was retrospective in nature and included patients with clinical or radiological suspicion of recurrent disease recurrence who were referred for PET/CT from January 2006 to June 2016. Diagnostic performance of PET/CT was evaluated for disease recurrence and its impact on management decisions was also estimated. PET-CT findings were confirmed with histopathology or cytology obtained by biopsy/FNAC/oesophageal brushings/fluid cytology. When tissue diagnosis was not available clinical and radiological follow up was used as reference standard.Results: 58 patients were referred for FDG PET/CT with clinico-radiological suspicion of recurrence. Relevant clinical and follow up data was available in 48 patients which were considered for analysis. Predominant presentation was with neck/supraclavicular swelling (suspected nodal recurrence) followed by dysphagia, abdominal pain, change of voice, shoulder pain. In 87.5% (42/48) patients FDG PET/CT findings were suggestive of disease recurrence. Histopathological confirmation was available in 32 patients, whereas in 10 patients recurrence was confirmed by radiological and clinical follow up. FDG PET/CT was negative for recurrence in 4 patients (8%). FDG PET/CT was false positive in 2 patients (4 %) as the biopsy findings from the anastomotic site revealed hyperplastic squamous epithelium, inflamed mucosa/stroma. 45% (22/48) patients were detected with distant metastasis (liver n=9, lung n=09, peritoneum n=05, adrenal n=3, abdominal wall n= 3 each, bones n=02, muscle n=2). 20 patients had loco-regional metastatic nodal disease. 25 % (05/20) of those had solitary nodal site whereas 75 % (15/20) patients had multi station nodal disease. Sensitivity, specificity, positive predictive value and negative predictive value of FDG PET-CT was found to be 100%, 66.6%, 95%, 100 % with accuracy of 0.95. Change in management was observed in significant proportion of patients 45% (22/48) from salvage radiotherapy/surgery to palliative chemotherapy/best supportive care based on evidence of distant metastases seen on FDG PET-CT. In patients with recurrent nodal disease, though treatment details were not available in some of cases, FDG PET-CT could have potentially changed radiation portals in those patients with evidence of multi station nodal disease (15/20)Conclusion: FDG PET-CT is highly sensitive in detection of recurrent disease in esophageal cancer patients after curative surgical resection. It can detect loco-regional and distant metastases in high proportion of patients thus changing the intent of management from radical salvage treatment to palliative chemotherapy/best supportive care.