Surgery Today

, Volume 44, Issue 7, pp 1258–1265 | Cite as

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

  • Hiroyuki YamadaEmail author
  • Masao Hosokawa
  • Kazuo Itoh
  • Toshinao Takenouchi
  • Yoshihiro Kinoshita
  • Tomohiro Kikkawa
  • Keita Sakashita
  • Shion Uemura
  • Yasunori Nishida
  • Takaya Kusumi
  • Shigeyuki Sasaki
Original Article



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.


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.


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).


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.


PET/CT Esophageal cancer Lymph node metastasis Diagnosis Squamous cell carcinoma 


Conflict of interest

We declare no potential conflicts of interest in association with this study.


  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–72.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.Google Scholar
  12. 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.Google Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Itoh K, Hosokawa M, et al. Companion to F-18FDG PET/CT (in Japanese). Tokyo: Medical Review; 2012.Google Scholar
  15. 15.
    The Japan Esophageal Society. Japanese Classification of Esophageal Cancer. April 2008 (The 10th ed., Revised Version) (in Japanese) Tokyo: Kanehara; 2008.Google Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.Google Scholar
  18. 18.
    Sobin L, Wittekind C. International Union Against Cancer (UICC). TNM Classification of Malignant Tumors. 6th ed. New York: Wiley; 2002.Google Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCentralPubMedGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 23.
    Torizuka T, Zasadny KR, Wahl RL. Diabetes decreases FDG accumulation in primary lung cancer. Clin Positron Imaging. 1999;2:281–7.PubMedCrossRefGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 27.
    Hosokawa M, Nishida Y, Koide T. Middle thoracic esophageal cancer (in Japasese). Shujutsu (Jpn Operation). 2007;61:271–7.Google Scholar
  28. 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.PubMedGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Hiroyuki Yamada
    • 1
    Email author
  • Masao Hosokawa
    • 1
  • Kazuo Itoh
    • 2
  • Toshinao Takenouchi
    • 3
  • Yoshihiro Kinoshita
    • 1
  • Tomohiro Kikkawa
    • 1
  • Keita Sakashita
    • 1
  • Shion Uemura
    • 1
  • Yasunori Nishida
    • 1
  • Takaya Kusumi
    • 1
  • Shigeyuki Sasaki
    • 4
  1. 1.Department of Digestive SurgeryKeiyukai Sapporo HospitalSapporoJapan
  2. 2.Center of Radiological ImageKeiyukai Sapporo HospitalSapporoJapan
  3. 3.Department of Surgical PathologyKeiyukai Sapporo HospitalSapporoJapan
  4. 4.Division of Medical ScienceHealth Sciences University of HokkaidoHokkaidoJapan

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