Skip to main content

Advertisement

SpringerLink
Log in

2-Deoxy-2-[F-18]Fluoro-d-Glucose–Positron Emission Tomography/Computed Tomography Imaging Evaluation of Esophageal Cancer

  • Research Article
  • Published:
Molecular Imaging and Biology Aims and scope Submit manuscript

Abstract

We evaluated the clinical utility of 2-deoxy-2-[F-18]fluoro-d-glucose (FDG)–positron emission tomography (PET)/computed tomography (CT) on the precise localization of pathologic foci and exclusion of normal variants in the imaging evaluation of patients with esophageal carcinoma. Combined PET/CT scans were performed in 60 patients (50 males, 10 females, age range 47–84 years) with history of esophageal carcinoma either at the time of initial diagnosis (group I, n = 14) or for surveillance and/or detection of recurrent and metastatic disease (group II, n = 46). Prior treatments included esophagectomy with gastric pull-up (n = 23), surgery and chemotherapy (n = 3), surgery and chemoradiation therapy (n = 10), chemotherapy alone (n = 5), radiation therapy alone (n = 2), and chemoradiation without surgery (n = 3). Diagnostic validation was by tissue sampling in three patients and clinical/radiological follow-up for up to 1.5 years in the remaining patients. In group I, discordant abnormalities were noted in seven patients. PET demonstrated hypermetabolism in normal-size lymph nodes on CT in three patients that were considered likely true positive in view of concurrent existence of other adjacent enlarged hypermetabolic lymph nodes in the same nodal basin. Hypometabolic incidental CT abnormalities of up to 1-cm lung nodules were noted in three patients and pleural effusion in one patient, which were considered true negative in view of no change on follow-up PET/CT studies. In group II, both PET and CT showed concordant abnormalities in 23 patients. The precise image fusion of hypermetabolism in a liver lesion allowed a diagnostic CT-guided biopsy in one patient. PET demonstrated true positive hypermetabolic abnormalities in four patients that localized to structures, which were normal by noncontrast CT criteria, and true negative in one patient with hepatic fatty deposits. PET showed decline in metabolic activity of the primary lesion in one patient after chemotherapy, while the corresponding CT abnormality remained unchanged. PET/CT image fusion provided relevant complementary diagnostic information in 14 patients with discordant findings (23% of total) that resulted in biopsy in three cases, institution of chemotherapy in four cases, and a wait-and-watch strategy in seven cases. In conclusion, our findings add to the current body of literature that suggests that FDG-PET/CT scanning may improve the imaging evaluation of patients with esophageal cancer by providing complementary structural-metabolic information. In particular, our findings support the notion that PET/CT may be the most appropriate imaging modality in the evaluation of patients of esophageal cancer that may impact patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Yang PC, Davis S (1988) Incidence of cancer of the esophagus in the US by histology types. Cancer 61(3):612–617

    Article  PubMed  CAS  Google Scholar 

  2. Younes M, Henson DE, Ertan A, Miller CC (2002) Incidence and survival trends of esophageal carcinoma in the United States: Racial and gender differences by histological type. Scand J Gastroenterol 37(12):1359–1365

    Article  PubMed  CAS  Google Scholar 

  3. Korst RJ, Altorki NK (2004) Imaging for esophageal tumors. Thorac Surg Clin 14:61–69

    Article  PubMed  Google Scholar 

  4. Kato H, Takita J, Miyazaki T, et al. (2003) Correlation of 18-F-fluorodeoxyglucose (FDG) accumulation with glucose transporter (Glut-1) expression in esophageal in esophageal squamous cell carcinoma. Anticancer Res 23:3263–3272

    PubMed  CAS  Google Scholar 

  5. Menzel CH, Dobert N, Rieker O, et al. (2003) 18F-deoxyglucose PET for the staging of esophageal cancer: Influence of histopathological subtype and tumor grading. Nuklearmediziner 42:90–93

    Google Scholar 

  6. Tohma T, Okazumi S, Makino H, et al. (2005) Relationship between glucose transporter, hexokinase and FDG-PET in esophageal cancer. Hepato-gastroenterol 52:486–490

    CAS  Google Scholar 

  7. Wallace MB, Nietert PJ, Earle C, et al. (2002) An analysis of multiple staging management strategies for carcinoma of the esophagus: Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg 74:1026–1032

    Article  PubMed  Google Scholar 

  8. Flamen P, Lerut A, van Cutsem E, et al. (2000) The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg 120:1085–1092

    Article  PubMed  CAS  Google Scholar 

  9. Townsend DW (2004) From 3-D positron emission tomography to 3-D positron emission tomography/computed tomography: What did we learn? Mol Imaging Biol 6(5):275–290

    Article  PubMed  Google Scholar 

  10. Rice TW (2000) Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin North Am 10:471–485

    CAS  Google Scholar 

  11. Kubota R, Yamada S, Kubota K, et al. (1992) Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: High accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 33(11):1972–1980

    PubMed  CAS  Google Scholar 

  12. Luketich JD, Schauer PR, Meltzer CC, et al. (1997) Role of positron emission tomography in staging esophageal cancer. Ann Thorac Surg 64:765–769

    Article  PubMed  CAS  Google Scholar 

  13. Skehan SJ, Brown AL, Thompson M, et al. (2000) Imaging features of primary and recurrent esophageal cancer at FDG-PET. Radiographics 21:713–723

    Google Scholar 

  14. Jadvar H, Cham DK, Conti PS (2003) Diagnostic evaluation of esophageal carcinoma with [F-18]-FDG-PET/CT. Mol Imaging Biol 5(3):188

    Google Scholar 

  15. Fukunaga T, Okazumi S, Koide Y, et al. (1998) Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET. J Nucl Med 39:1002–1007

    PubMed  CAS  Google Scholar 

  16. Kato H, Kuwano H, Nakajima M, et al. (2002) Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer 94:921–928

    Article  PubMed  Google Scholar 

  17. McAteer D, Wallis F, Couper G, et al. (1999) Evaluation of 18F-FDG positron emission tomography in gastric and esophageal carcinoma. Br J Radiol 72:525–529

    PubMed  CAS  Google Scholar 

  18. Choi JY, Lee KH, Shim YM, et al. (2000) Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG-PET. J Nucl Med 41:808–815

    PubMed  CAS  Google Scholar 

  19. Meltzer CC, Luketich JD, Friedman D, et al. (2000) Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography. Clin Nucl Med 25:882–887

    Article  PubMed  CAS  Google Scholar 

  20. Wren SM, Stijns P, Srinivas S (2002) Positron emission tomography in the initial staging of esophageal cancer. Arch Surg 137:1001–1006

    Article  PubMed  Google Scholar 

  21. Himeno S, Yasuda S, Shimada H, et al. (2002) Evaluation of esophageal cancer by positron emission tomography. Jpn J Clin Oncol 32:340–346

    Article  PubMed  Google Scholar 

  22. Rasanen JV, Sihvo EI, Knuuti MJ (2003) Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol 10:954–960

    Article  PubMed  Google Scholar 

  23. Heeren PA, Jager PL, Bongaerts F, et al. (2004) Detection of distant metastases in esophageal cancer with (18)F-FDG-PET. J Nucl Med 45:980–987

    PubMed  Google Scholar 

  24. Liberale G, van Lathem JL, Gay F, et al. (2004) The role of PET scan in the preoperative management of esophageal cancer. Eur J Surg Oncol 30:942–947

    PubMed  CAS  Google Scholar 

  25. Kato H, Miyazaki T, Nakajima M, et al. (2005) The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer 103:148–156

    Article  PubMed  Google Scholar 

  26. Kneist W, Schreckenberger M, Bartenstein P, et al. (2003) Positron emission tomography for staging esophageal cancer: Does it lead to a different therapeutic approach? World J Surg 27:1105–1112

    Article  PubMed  Google Scholar 

  27. van Westreenen HL, Heeren PA, Jager PL, et al. (2003) Pitfalls of positive findings in staging esophageal cancer with F-18-fluorodeoxyglucose positron emission tomography. Ann Surg Oncol 10:1100–1105

    Article  PubMed  Google Scholar 

  28. Bar-Shalom R, Guralnik L, Tsalic M, et al. (2006) The additional value of PET/CT over PET in FDG imaging of esophageal cancer. Eur J Nucl Med Mol Imaging (in press)

  29. Flanagan FL, Dehdashti F, Siegel BA, et al. (1997) Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 168:417–424

    PubMed  CAS  Google Scholar 

  30. Kole AC, Plukker JT, Nieweg OE, Vaalburg W (1998) Positron emission tomography for staging of esophageal and gastroesophageal malignancy. Br J Cancer 78:521–527

    PubMed  CAS  Google Scholar 

  31. Rankin SC, Taylor H, Cook GJ, Mason R (1998) Computed tomography and positron emission tomography in the pre-operative staging of esophageal carcinoma. Clin Radiol 53:659–665

    Article  PubMed  CAS  Google Scholar 

  32. Luketich JD, Friedman DM, Weigel TL (1999) Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg 68:1133–1136

    Article  PubMed  CAS  Google Scholar 

  33. Flamen P, Lerut A, van Cutsem E, et al. (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18:3202–3210

    PubMed  CAS  Google Scholar 

  34. Yoon YC, Lee KS, Shim YM, et al. (2003) Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG-PET for presurgical detection prospective study. Radiology 227:764–770

    Article  PubMed  Google Scholar 

  35. Sihvo EI, Rasanen JV, Knuuti MJ, et al. (2004) Adenocarcinoma of the esophagus and the esophagogastric junction: Positron emission tomography improves staging and prediction of survival in distant but not in locoregional disease. J Gastrointest Surg 8:988–996

    Article  PubMed  Google Scholar 

  36. Kato H, Miyazaki T, Nakajima M, et al. (2004) Value of positron emission tomography in the diagnosis of recurrent esophageal carcinoma. Br J Surg 91:1004–1009

    Article  PubMed  CAS  Google Scholar 

  37. Kim K, Park SJ, Kim BT, et al. (2001) Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography. Ann Thorac Surg 71:290–294

    Article  PubMed  CAS  Google Scholar 

  38. Kneist W, Schreckenberger M, Bartenstein P, et al. (2004) Prospective evaluation of positron emission tomography in the preoperative staging of esophageal carcinoma. Arch Surg 139:1043–1049

    Article  PubMed  Google Scholar 

  39. Larson SM, Schoder H, Yeung H (2004) Positron emission tomography/computerized tomography functional imaging of esophageal and colorectal cancer. Cancer J 10:243–250

    Article  PubMed  Google Scholar 

  40. van Westreenen HL, Westerterp M, Bossuyt PM, et al. (2004) Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22:3805–3812

    Article  PubMed  Google Scholar 

  41. Yeung HW, Macapinlac HA, Mazumdar M, et al. (1999) FDG-PET in esophageal cancer. Incremental value over computed tomography. Clin Positron Imaging 2:255–260

    Article  PubMed  Google Scholar 

  42. Imdahl A, Hentschel M, Kleimaier M, et al. (2004) Impact of FDG-PET for staging of esophageal cancer. Langenbecks Arch Surg 389:283–288

    Article  PubMed  Google Scholar 

  43. van Westreenen HL, Heeren PA, van Dullemen HM, et al. (2005) Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg 9:44–61

    Article  Google Scholar 

  44. Ichiya Y, Kuwabara Y, Otsuka M, et al. (1991) Assessment of response to cancer therapy using fluorine-18-fluorodeoxyglucose and positron emission tomography. J Nucl Med 32:1655–1660

    PubMed  CAS  Google Scholar 

  45. Couper GW, McAteer D, Wallis F, et al. (1998) Detection of response to chemotherapy using positron emission tomography in patients with esophageal and gastric cancer. Br J Surg 85:1403–1406

    Article  PubMed  CAS  Google Scholar 

  46. Kato H, Kuwano H, Nakajima M, et al. (2002) Usefulness of positron emission tomography for assessing the response of neoadjuvant chemoradiotherapy in patients with esophageal cancer. Am J Surg 184:279–283

    Article  PubMed  Google Scholar 

  47. Arslan N, Miller TR, Dehdashti F, et al. (2002) Evaluation of response to neoadjuvant therapy by quantitative 2-deoxy-2-[18F]fluoro-d-glucose with positron emission tomography in patients with esophageal cancer. Mol Imaging Biol 4:301–310

    Article  PubMed  Google Scholar 

  48. Brink I, Hentschel M, Bley TA, et al. (2004) Effects of neoadjuvant radio-chemotherapy on 18F-FDG-PET in esophageal carcinoma. Eur J Surg Oncol 30:544–550

    Article  PubMed  CAS  Google Scholar 

  49. Cerfolio RJ, Bryant AS, Ohja B, et al. (2005) The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg 129:1232–1241

    Article  PubMed  Google Scholar 

  50. Song SY, Kim JH, Ryu JS, et al. (2005) FDG-PET in the prediction of pathologic response after neoadjuvant chemoradiotherapy in locally advanced, resectable esophageal cancer. Int J Radiat Oncol Biol Phys 63:1053–1059

    PubMed  Google Scholar 

  51. Konski A, Doss M, Milestone B, et al. (2005) The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma. Int J Radiat Oncol Biol Phys 61:1123–1128

    PubMed  Google Scholar 

  52. Swisher SG, Maish M, Erasmus JJ, et al. (2004) Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 78:1152–1160

    Article  PubMed  Google Scholar 

  53. Vrieze O, Haustermans K, De Wever W, et al. (2004) Is there a role for FDG-PET in radiotherapy planning in esophageal carcinoma? Radiother Oncol 73:269–275

    Article  PubMed  Google Scholar 

  54. Weider HA, Brucher BL, Zimmerman F (2004) Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 22:900–908

    Article  Google Scholar 

  55. Arslan N, Miller TR, Dehdashti F, et al. (2002) Evaluation of response to neoadjuvant therapy by quantitative 2-deoxy-2-[18F]fluoro-d-glucose with positron emission tomography in patients with esophageal cancer. Mol Imaging Biol 4(4):301–310

    Article  PubMed  Google Scholar 

  56. Brucher BL, Weber W, Bauer M, et al. (2001) Neoadjuvant therapy of esophageal squamous cell carcinoma: Response evaluation by positron emission tomography. Ann Surg 233:300–309

    Article  PubMed  CAS  Google Scholar 

  57. Flamen P, van Cutsem E, Lerut A, et al. (2002) Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced esophageal cancer. Ann Oncol 13:361–368

    Article  PubMed  CAS  Google Scholar 

  58. Downey RJ, Akhurst T, Ilson D, et al. (2003) Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: Results of a prospective trial. J Clin Oncol 21:428–432

    Article  PubMed  Google Scholar 

  59. Flamen P, Lerut T, Haustermans K, et al. (2004) Position of positron emission tomography and other imaging diagnostic modalities in esophageal cancer. Q J Nucl Med Mol Imaging 48:96–108

    PubMed  CAS  Google Scholar 

  60. Choi JY, Jang HJ, Shim YM, et al. (2004) 18F-FDG-PET in patients with esophageal squamous cell carcinoma undergoing curative surgery: Prognostic implications. J Nucl Med 45:1843–1850

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. PET Imaging Science Center, Division of Nuclear Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA

    Hossein Jadvar MD, PhD, MPH, Robert W. Henderson MD & Peter S. Conti MD, PhD

Authors
  1. Hossein Jadvar MD, PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert W. Henderson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter S. Conti MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hossein Jadvar MD, PhD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jadvar, H., Henderson, R.W. & Conti, P.S. 2-Deoxy-2-[F-18]Fluoro-d-Glucose–Positron Emission Tomography/Computed Tomography Imaging Evaluation of Esophageal Cancer. Mol Imaging Biol 8, 193–200 (2006). https://doi.org/10.1007/s11307-006-0036-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11307-006-0036-5

Keywords

Search

Navigation