Whole-Body FDG Positron Emission Tomographic Imaging for Staging Esophageal Cancer: Comparison with Computed Tomography

PURPOSEThe aim of the authors in this study was to critically evaluate the role of whole-body positron emission tomographic (PET) imaging with fluorine-18 fluorodeoxyglucose (FDG) in staging esophageal cancer, and further to compare this method with conventional imaging with computed tomography (CT)...

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Published in:Clinical nuclear medicine 2000-11, Vol.25 (11), p.882-887
Main Authors: MELTZER, CAROLYN CIDIS, LUKETICH, JAMES D, FRIEDMAN, DAVID, CHARRON, MARTIN, STROLLO, DIANE, MEEHAN, MANDY, URSO, GRACE K, DACHILLE, MARSHA A, TOWNSEND, DAVID W
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnostic imaging
Adenocarcinoma - pathology
Adenocarcinoma - secondary
Biological and medical sciences
Carcinoma, Squamous Cell - diagnostic imaging
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - secondary
Digestion. Liver. Biliary tract. Spleen. Pancreas
Esophageal Neoplasms - diagnostic imaging
Esophageal Neoplasms - pathology
Esophagus
Female
Fluorodeoxyglucose F18
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Minimally Invasive Surgical Procedures
Neoplasm Staging
Radionuclide investigations
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Thoracic Neoplasms - diagnostic imaging
Tomography, Emission-Computed
Tomography, X-Ray Computed
Tumors
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Summary:PURPOSEThe aim of the authors in this study was to critically evaluate the role of whole-body positron emission tomographic (PET) imaging with fluorine-18 fluorodeoxyglucose (FDG) in staging esophageal cancer, and further to compare this method with conventional imaging with computed tomography (CT). MATERIALS AND METHODSThe authors performed independent, blinded retrospective evaluations of FDG PET images obtained in 47 patients referred for the initial staging of esophageal cancer before minimally invasive surgical staging. Twenty PET studies from patients with nonesophageal thoracic cancers were randomly selected for inclusion in the PET readings. In a subset of 37 of 47 cases, the PET findings were compared with independent readings of CT studies acquired within the same 6-week interval. The utility of the imaging findings was evaluated using a high-sensitivity interpretation (i.e., assigning equivocal findings as positive) and a low-sensitivity interpretation (i.e., assigning equivocal findings as negative). RESULTSPET was less sensitive (41% in high-sensitivity mode, 35% in low-sensitivity mode) than CT (63% to 87%) for diagnosing tumor involvement in locoregional lymph nodes, which was identified by surgical assessment in 72% of patients. Notable, however, was the greater specificity of PET-determined nodal sites (to approximately 90%) compared with CT (14% to 43%). In detecting histologically proved distant metastases (n = 10), PET performed considerably better when applied in the high-sensitivity mode, with a sensitivity rate of approximately 70% and a specificity rate of more than 90% in the total group and in the subset of patients with correlative CT data. In the low-sensitivity mode, CT identified only two of seven metastatic sites, whereas the high-sensitivity mode resulted in an unacceptably high rate of false-positive readings (positive predictive value, 29%). PET correctly identified one additional site of metastasis that was not detected by CT. CONCLUSIONSThe relatively low sensitivity of PET for identifying locoregional lesions precludes its replacement of conventional CT staging. However, the primary advantage of PET imaging is its superior specificity for tumor detection and improved diagnostic value for distant metastatic sites, features that may substantially affect patient management decisions. In conclusion, PET imaging is useful in the initial staging of esophageal cancer and provides additional and complementary information to th
ISSN:0363-9762
1536-0229
DOI:10.1097/00003072-200011000-00005