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European Journal of Nuclear Medicine and Molecular Imaging

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01-06-2014 | Original Article

Diagnostic accuracy of ¹⁸F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma

Authors: Punit Sharma, Sachin Jain, Sellam Karunanithi, Sujoy Pal, Pramod Kumar Julka, Sanjay Thulkar, Arun Malhotra, Chandrasekhar Bal, Rakesh Kumar

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2014

Abstract

Purpose

To evaluate the role of ¹⁸F-FDG PET/CT in the detection of recurrence in patients with oesophageal carcinoma, suspected clinically or following conventional investigations.

Methods

This was a retrospective study. Data from 180 patients (age 56.3 ± 10.4 years; 126 men, 54 women) with histopathologically proven oesophageal carcinoma (squamous cell 115, adenocarcinoma 59, neuroendocrine carcinoma 4, small cell 1, poorly differentiated 1) who had undergone 227 ¹⁸F-FDG PET/CT studies for suspected recurrence were analysed. Recurrence was suspected clinically or following conventional investigations. PET/CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local, nodal and distant recurrence. Results were compared to those from contrast-enhanced (CE) CT when available (109 patients). Clinical/imaging follow-up (minimum 6 months) with histopathology (when available) was taken as the reference standard.

Results

Of the 227 ¹⁸F-FDG PET/CT studies,166 were positive and 61 were negative for recurrent disease. PET/CT showed local recurrence in 134, nodal recurrence in 115 and distant recurrence in 47, with more than one site of recurrence in 34. The PET/CT findings were true-positive in 153 studies, true-negative in 54, false-positive in 13 and false-negative in 7. The sensitivity of ¹⁸F-FDG PET/CT was 96 %, the specificity was 81 %, the positive and negative predictive values were 92 % and 89 %, respectively, and the accuracy was 91 %. PET/CT showed similar accuracy in patients with squamous cell carcinoma and in those with adenocarcinoma (P = 0.181).¹⁸F-FDG PET/CT was more specific than CECT (67 % vs. 21 %; P < 0.0001). PET/CT was superior to CECT for the detection of nodal recurrence (P < 0.0001), but not local recurrence (P = 0.093) or distant metastases (P = 0.441).

Conclusion

¹⁸F-FDG PET/CT shows high accuracy in the detection of suspected recurrence in patients with oesophageal carcinoma. It is more specific than and is superior to CECT in the detection of nodal recurrence.

Baba M, Aikou T, Yoshinaka H, Natsugoe S, Fukumoto T, Shimazu H, et al. Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg. 1994;219:310–6.PubMedCentralPubMedCrossRef

Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–72.PubMedCentralPubMedCrossRef

Matsubara T, Ueda M, Takahashi T, Nakajima T, Nishi M. Localization of recurrent disease after extended lymph node dissection for carcinoma of the thoracic esophagus. J Am Coll Surg. 1996;182:340–6.PubMed

Bhansali MS, Fujita H, Kakegawa T, Yamana H, Ono T, Hikita S, et al. Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg. 1997;21:275–81.PubMedCrossRef

Hulscher JB, van Sandick JW, Tijssen JG, Obertop H, van Lanschot JJ. The recurrence pattern of esophageal carcinoma after transhiatal resection. J Am Coll Surg. 2000;191:143–8.PubMedCrossRef

Mariette C, Balon JM, Piessen G, Fabre S, Van Seuningen I, Triboulet JP. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616–23.PubMedCrossRef

Law SY, Fok M, Wong J. Pattern of recurrence after oesophageal resection for cancer: clinical implications. Br J Surg. 1996;83:107–11.PubMedCrossRef

Raoul JL, Le Prisé E, Meunier B, Julienne V, Etienne PL, Gosselin M, et al. Combined radiochemotherapy for postoperative recurrence of oesophageal cancer. Gut. 1995;37:174–6.PubMedCentralPubMedCrossRef

Kato H, Miyazaki T, Nakajima M, Fukuchi M, Manda R, Kuwano H. Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma. Br J Surg. 2004;91:1004–9.PubMedCrossRef

10.

Flamen P, Lerut A, Van Cutsem E, Cambier JP, Maes A, De Wever W, et al. The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg. 2000;120:1085–92.PubMedCrossRef

11.

Skehan SJ, Brown AL, Thompson M, Young JE, Coates G, Nahmias C. Imaging features of primary and recurrent esophageal cancer at FDG PET. Radiographics. 2000;20:713–23.PubMedCrossRef

12.

Westerterp M, van Westreenen HL, Reitsma JB, Hoekstra OS, Stoker J, Fockens P, et al. Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy – systematic review. Radiology. 2005;236:841–51.PubMedCrossRef

13.

Swisher SG, Erasmus J, Maish M, Correa AM, Macapinlac H, Ajani JA, et al. 2-Fluoro- 2-deoxy-D-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer. 2004;101:1776–85.PubMedCrossRef

14.

Wieder HA, Beer AJ, Lordick F, Ott K, Fischer M, Rummeny EJ, et al. Comparison of changes in tumor metabolic activity and tumor size during chemotherapy of adenocarcinomas of the esophagogastric junction. J Nucl Med. 2005;46:2029–34.PubMed

15.

Cheze-Le Rest C, Metges JP, Teyton P, Jestin-Le Tallec V, Lozac’h P, Volant A, et al. Prognostic value of initial fluorodeoxyglucose-PET in esophageal cancer: a prospective study. Nucl Med Commun. 2008;29:628–35.PubMedCrossRef

16.

Teyton P, Metges JP, Atmani A, Jestin-Le Tallec V, Volant A, Visvikis D, et al. Use of positron emission tomography in surgery follow-up of esophageal cancer. J Gastrointest Surg. 2009;13:451–8.PubMedCrossRef

17.

Guo H, Zhu H, Xi Y, Zhang B, Li L, Huang Y, et al. Diagnostic and prognostic value of 18F-FDG PET/CT for patients with suspected recurrence from squamous cell carcinoma of the esophagus. J Nucl Med. 2007;48:1251–8.PubMedCrossRef

18.

Jadvar H, Henderson RW, Conti PS. 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography/computed tomography imaging evaluation of esophageal cancer. Mol Imaging Biol. 2006;8:193–200.PubMedCrossRef

19.

Yuan S, Yu Y, Chao KS, Fu Z, Yin Y, Liu T, et al. Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer. J Nucl Med. 2006;47:1255–9.PubMed

20.

Yamashita H, Nakagawa K, Tago M, Nakamura N, Shiraishi K, Ohtomo K. Salvage radiotherapy for postoperative loco-regional recurrence of esophageal cancer. Dis Esophagus. 2005;18:215–20.PubMedCrossRef

21.

Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Setoyama T, Uenosono Y, et al. The role of salvage surgery for recurrence of esophageal squamous cell cancer. Eur J Surg Oncol. 2006;32:544–7.PubMedCrossRef

22.

Israel O, Mor M, Guralnik L, Hermoni N, Gaitini D, Bar-Shalom R, et al. Is 18F-FDG PET/CT useful for imaging and management of patients with suspected occult recurrence of cancer? J Nucl Med. 2004;45:2045–51.PubMed

23.

Chen G, Wang Z, Liu XY, Liu FY. Recurrence patterns of esophageal cancer after Ivor-Lewis esophagectomy – a report of 196 cases. Ai Zheng. 2006;25:96–9.PubMed

24.

Rice TW. Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest. Surg Clin North Am. 2000;10:471–85.

25.

Pham KH, Ramaswamy MR, Hawkins RA. Advances in positron emission tomography imaging for the GI tract. Gastrointest Endosc. 2002;55:S53–63.PubMedCrossRef

26.

Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT. Detection of distant metastases in esophageal cancer with (18)F-FDG-PET. J Nucl Med. 2004;45:980–7.PubMed

27.

Liberale G, Van Laethem JL, Gay F, Goldman S, Nagy N, Coppens E, et al. The role of PET scan in the preoperative management of esophageal cancer. Eur J Surg Oncol. 2004;30:942–7.PubMedCrossRef

28.

van Westreenen HL, Heeren PA, Jager PL, van Dullemen HM, Groen H, Plukker JT. Pitfalls of positive findings in staging esophageal cancer with F-18-fluorodeoxyglucose positron emission tomography. Ann Surg Oncol. 2003;10:1100–5.PubMedCrossRef

29.

Yeung HW, Macapinlac HA, Mazumdar M, Bains M, Finn RD, Larson SM. FDG-PET in esophageal cancer: incremental value over computed tomography. Clin Positron Imaging. 1999;2:255–60.PubMedCrossRef

Title: Diagnostic accuracy of 18F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma
Authors: Punit Sharma
Sachin Jain
Sellam Karunanithi
Sujoy Pal
Pramod Kumar Julka
Sanjay Thulkar
Arun Malhotra
Chandrasekhar Bal
Rakesh Kumar
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2664-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic accuracy of ¹⁸F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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