Positron Emission Tomography–Computed Tomography in Predicting Locoregional Invasion in Esophageal Squamous Cell Carcinoma

doi:10.1016/j.athoracsur.2009.02.065

The Annals of Thoracic Surgery

Volume 87, Issue 5, May 2009, Pages 1564-1568

https://doi.org/10.1016/j.athoracsur.2009.02.065 Get rights and content

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Patients and Methods

This retrospective analysis was based on prospectively collected data. From March 2007 to December 2008, 200 patients with esophageal cancer were admitted to the division of thoracic surgery of the department of surgery at Taipei-Veterans General Hospital. The staging workup included physical examination, laboratory tests, esophagogastroduodenoscopy, flexible bronchoscopy, barium esophagography, CT scan from neck to upper abdomen, and whole body PET/CT. Patients without distant metastasis or

Tumor Invasion Depth

The patient characteristics are summarized in Table 1. The mean SUV_max of the primary tumor was 11.64 ± 5.00 (range, 0 to 23.00). The mean SUV_max of the primary tumor in patients grouped according to T stage was 5.09 ± 4.00 for T1 lesions, 14.17 ± 2.46 for T2; 13.32 ± 3.96 for T3, and 10.37 ± 1.94 for T4. The SUV_max was significantly lower for T1 stage tumors than for T2 and T3 stage tumors (T1 versus T2, p = 0.001; T1 versus T3, p < 0.001). We further stratified patients into two groups using

Comment

Although many studies suggest the value of FDT-PET or PET/CT in staging as well as prediction of treatment response and prognosis, the results for esophageal cancer have been contradictory [2, 5, 6]. Van Westreenen and associates [14] reported high false positive (7.5%) and false negative (4.5%) rates for FDG-PET in detecting distant metastasis. They also proposed that FDG-PET has a limited role in staging esophageal cancer, especially in patients with early tumors [14]. A study by Gillham and

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Citation Excerpt :
Two studies were originally published in other languages (bilingual abstracts)23,24 but they had English equivalents so were included. Another 15 articles were excluded due to an overlap in study population,25–28 missing essential data,29–33 inappropriate reference standard34,35 and administration of chemotherapy before re-staging or RT planning.36–39 Finally, only 37 studies were included in this review.40–76
The aim of this study was to systematically review published data on the efficacy of positron emission tomography–computed tomography (PET–CT) in the radiotherapy planning process of patients with oesophageal carcinoma.
A systematic search of the PubMed, CINAHL, Cochrane Library and ScienceDirect databases was performed. The quality of the included studies was appraised using validated assessment tool. Data of the studies were synthesized, compared and evaluated by constructing evidentiary tables.
The 37 included studies, comprising a total sample size of 1921 patients, had moderate methodological quality. Overall primary tumour detection rate was 92.7%, and pooling estimate of specificity was 88% (95%CI: 83–91%) for local lymph node metastasis. The pooled studies presented heterogeneity for sensitivity (p < 0.01). The introduction of PET–CT to the radiotherapy planning process has facilitated target volume delineation. A standardized uptake value (SUV) of 2.5 could be used in supplementation to visual assessment by a qualified practitioner.
PET–CT has a high specificity but due to its variable sensitivity, information from other clinical investigations should still be sought. Discretion and sound clinical judgment must also be exercised before using the biologic information for radiotherapy planning.
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S3 guideline on the diagnosis and treatment of squamous cell carcinomas and adenocarcinomas of the esophagus: Version 3.1 - June 2022 - Association of the Scientific Medical Societies in Germany (AWMF) registry number: 021/023OL
2023, Zeitschrift fur Gastroenterologie

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Original articleGeneral thoracicPositron Emission Tomography–Computed Tomography in Predicting Locoregional Invasion in Esophageal Squamous Cell Carcinoma

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Tumor Invasion Depth

Comment

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Resection for esophageal cancer: strategies for optimal management

Ann Thorac Surg

Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma

Cancer

The importance of PET in the diagnosis and response evaluation of esophageal cancer

Dis Esophagus

Role of positron emission tomography in the staging of esophageal cancer

Scan J Gastroenterol

Original article
General thoracic
Positron Emission Tomography–Computed Tomography in Predicting Locoregional Invasion in Esophageal Squamous Cell Carcinoma