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01-07-2014 | Original Article

Diagnostic value of ¹⁸F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma

Authors: Hiroyuki Yamada, Masao Hosokawa, Kazuo Itoh, Toshinao Takenouchi, Yoshihiro Kinoshita, Tomohiro Kikkawa, Keita Sakashita, Shion Uemura, Yasunori Nishida, Takaya Kusumi, Shigeyuki Sasaki

Published in: Surgery Today | Issue 7/2014

Abstract

Purpose

This study investigated the diagnostic accuracy of hybrid positron-emission tomography/computed tomography (PET/CT) for lymph node (LN) metastasis of esophageal cancer. We also investigated the correlation between the size of metastatic nests and the detection by PET/CT.

Methods

Two hundred and fifty-eight patients with esophageal squamous cell carcinoma who underwent esophagectomy with two- or three-field radical lymphadenectomy were analyzed retrospectively. We compared the diagnosis of preoperative PET/CT to the postoperative histopathological examination by each anatomical field (n = 1,231) in all 258 patients. The metastatic LNs resected from PET/CT positive fields were classified as belonging to the PET/CT-N-positive group (n = 229) and those from negative fields as belonging to the PET/CT-N-negative group (n = 352). The cross-sectional areas of metastatic nests were measured in each metastatic LN.

Results

Of the 1,231 fields, 275 (22 %) were positive for metastasis, including 581 LNs from 408 regional LN stations. The sensitivity and specificity of PET/CT examined by each anatomical field were 25.8 and 97.8 %, respectively. The median area of metastatic nests was 17.7 mm² in the PET/CT-N-positive group, and 7.7 mm² in the PET/CT-N-negative group (p < 0.001).

Conclusions

A significant correlation was suggested between the nest size and detection by PET/CT. Because of its low sensitivity, PET/CT alone is insufficient to determine the surgical procedures, especially when considering reduction surgery.

Bollschweiler E, Baldus S, Schröder W, Prenzel K, Gutschow C, Schneider PM, et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy. 2006;38:149–56.PubMedCrossRef

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

Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–83.PubMedCentralPubMedCrossRef

Kakeji Y, Yamamoto M, Ito S, Sugiyama M, Egashira A, Saeki H, et al. Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection. Surg Today. 2012;42(4):351–8.PubMedCrossRef

Kato H, Nakajima M. The efficacy of FDG-PET for the management of esophageal cancer: review article. Ann Thorac Cardiovasc Surg. 2012;18:412–9.PubMedCrossRef

Kato H, Kimura H, Nakajima M, Sakai M, Sano A, Tanaka N, et al. The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer. Oncol Rep. 2008;20:857–62.PubMed

Yen T-J, Chung C-S, Wu Y-W, Yen R-F, Cheng M-F, Lee J-M, et al. Comparative study between endoscopic ultrasonography and positron emission tomography-computed tomography in staging patients with esophageal squamous cell carcinoma. Dis Esophagus. 2012;25:40–7.PubMedCrossRef

Itoh K, Hosokawa M, Fujita M. <18F>FDG-PET/CT in esophageal cancer: comparison between PET and histopathological evaluation on metastasis to locoregional lymph node. (in Japanese). Jpn J Clin Radiol. 2008;53:501–7.

Han D, Yu J, Zhong X, Fu Z, Mu D, Zhang B, et al. Comparison of the diagnostic value of 3-deoxy-3-18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of regional lymph node in thoracic esophageal squamous cell carcinoma: a pilot study. Dis Esophagus. 2012;25:416–26.PubMedCrossRef

10.

Tanabe S, Naomoto Y, Shirakawa Y, Fujiwara Y, Sakurama K, Noma K, et al. F-18 FDG PET/CT contributes to more accurate detection of lymph nodal metastasis from actively proliferating esophageal squamous cell carcinoma. Clin Nucl Med. 2011;36:854–9.PubMedCrossRef

11.

Wang F, Shen L-Y, Ma S-H, Li N, Yang Z, Chen K-N. Advantages of positron emission tomography-computed tomography imaging in esophageal squamous cell carcinoma. Dis Esophagus. 2012. doi:10.1111/j.1442-2050.2012.01407.x.

12.

Yoon SK, Jung JI, Park MJ, Park HJ, Ahn MI, Park JG, et al. Multidetector CT assessment of lymph node size for nodal staging in patients with potentially operable squamous esophageal cancer and the 18F-FDG positron emission tomography CT correlation. J Korean Soc Radiol. 2010;62:235–43.

13.

Okada M, Murakami T, Kumano S, Kuwabara M, Shimono T, Hosono M, et al. Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer. Ann Nucl Med. 2009;23:73–80.PubMedCrossRef

14.

Itoh K, Hosokawa M, et al. Companion to F-18FDG PET/CT (in Japanese). Tokyo: Medical Review; 2012.

15.

The Japan Esophageal Society. Japanese Classification of Esophageal Cancer. April 2008 (The 10th ed., Revised Version) (in Japanese) Tokyo: Kanehara; 2008.

16.

Natsugoe S, Mueller J, Stein H, Feith M, Höfler H, Siewert J. Micrometastasis and tumor cell microinvolvement of lymph nodes from esophageal squamous cell carcinoma: frequency, associated tumor characteristics, and impact on prognosis. Cancer. 1998;83:858–66.PubMedCrossRef

17.

Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.

18.

Sobin L, Wittekind C. International Union Against Cancer (UICC). TNM Classification of Malignant Tumors. 6th ed. New York: Wiley; 2002.

19.

Kato H, Kuwano H, Nakajima M, Miyazaki T, Yoshikawa M, Ojima H, et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002;94:921–8.PubMedCrossRef

20.

Pedersen P. Warburg, me and Hexokinase 2: multiple discoveries of key molecular events underlying one of cancers’ most common phenotypes, the ‘Warburg Effect’, i.e., elevated glycolysis in the presence of oxygen. J Bioenerg Biomembr. 2007;39:211–22.PubMedCrossRef

21.

Haley M, Konski A, Li T, Jonathan DC, Maurer A, Haluszka O, et al. Influence of diabetes on the interpretation of PET scans in patients with esophageal cancer. GCR. 2009;3:149–52.PubMedCentralPubMed

22.

Gorenberg M, Hallett W, O’Doherty MJ. Does diabetes affect [¹⁸F]FDG standardized uptake values in lung cancer? Eur J Nucl Med. 2002;29:1324–7.CrossRef

23.

Torizuka T, Zasadny KR, Wahl RL. Diabetes decreases FDG accumulation in primary lung cancer. Clin Positron Imaging. 1999;2:281–7.PubMedCrossRef

24.

Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer—a PET study. J Nucl Med. 1993;34:1–6.PubMed

25.

Yasuda T, Higuchi I, Yano M, Miyata H, Yamasaki M, Takiguchi S, et al. The impact of 18F-fluorodeoxyglucose positron emission tomography positive lymph nodes on postoperative recurrence and survival in resectable thoracic esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;19:652–60.PubMedCrossRef

26.

Strauss L. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med. 1996;23:1409–15.PubMedCrossRef

27.

Hosokawa M, Nishida Y, Koide T. Middle thoracic esophageal cancer (in Japasese). Shujutsu (Jpn Operation). 2007;61:271–7.

28.

Mu DB, Wang SP, Yang WF, Fu Z, Chen XX, Sun XR, et al. Correlation between FDG PET/CT and the expression of glutI and ki-67 antigen in esophageal cancer (in Chinese). Zhonghua Zhong Liu Za Zhi. 2007;29:30–3.PubMed

Title: Diagnostic value of 18F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma
Authors: Hiroyuki Yamada
Masao Hosokawa
Kazuo Itoh
Toshinao Takenouchi
Yoshihiro Kinoshita
Tomohiro Kikkawa
Keita Sakashita
Shion Uemura
Yasunori Nishida
Takaya Kusumi
Shigeyuki Sasaki
Publication date: 01-07-2014
Publisher: Springer Japan
Published in: Surgery Today / Issue 7/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-013-0725-z

At a glance: The STEP trials

Springer Medicine

Diagnostic value of ¹⁸F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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