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Significance of 18F-Fluorodeoxyglucose Uptake at the Gastroesophageal Junction: Comparison of PET to Esophagogastroduodenoscopy

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Abstract

Background

Positron emission tomography-computed tomography (PET/CT) occasionally reveals unexpected uptake of 18F-fluorodeoxyglucose (18F-FDG) at the gastroesophageal junction (GEJ). The aim of this study was to determine the importance of unexpected 18F-FDG uptake at the GEJ on PET/CT by correlating this finding with endoscopy results.

Methods

We reviewed medical records from June 2009 to October 2012 to identify patients in our Veterans Affairs Medical Center who had an esophagogastroduodenoscopy (EGD) performed within 6 months of a PET/CT. Metabolic activity at the GEJ was quantified with standardized uptake values (SUV) and correlated with EGD and histopathology results.

Results

A total of 219 patients were identified and assigned to one of five groups based upon EGD findings: esophageal malignancy (n = 34), esophagitis (n = 21), Barrett’s esophagus (n = 8), other non-malignant disorders (n = 5), and normal (n = 151). The mean SUVMax for the groups was 6.72, 2.47, 2.40, 3.48, and 2.06, respectively. SUVMax and SUVMean were significantly higher in the esophageal malignancy group than in all other groups (p < 0.001). SUV for patients with high-grade esophagitis was greater than in patients with low-grade esophagitis. A SUVMax ≥3.5 was found to predict necessity for EGD with a positive predictive value of 79 %. A SUVMax ≤2.2 yielded a negative predictive value of 86 %.

Conclusion

Differentiation between benign and potentially significant disease at the GEJ may be possible with quantification of incidental 18F-FDG uptake at PET/CT. Our results suggest thresholds that may help determine need for further endoscopic evaluation in patients with abnormal metabolic activity at the GEJ.

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References

  1. Cotton PB, Hawes RH, Barkun A, et al. Excellence in endoscopy: toward practical metrics. Gastrointest Endosc. 2006;63:286.

    Article  PubMed  Google Scholar 

  2. Baus MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. SeminRadiatOncol.. 2013;23:3–9.

    Google Scholar 

  3. Lerut T: Carcinoma of the esophagus and gastro-esophageal junction. In: Holzheimer RG, Mannick JA: Surgical Treatment-Evidence-Based and Problem-Oriented. Department of Thoracic Surgery, University of Leuven, Belgium. 2001.

  4. Younes M, Henson DE, Ertan A, Miller CC. Incidence and survival trends of esophageal carcinoma in the United States: racial and gender differences by histological type. Scand J Gastroenterol. 2002;37:1359.

    Article  CAS  PubMed  Google Scholar 

  5. Lightdale CJ. Esophageal cancer. Am J Gastroenterol. 1999;94:20.

    Article  CAS  PubMed  Google Scholar 

  6. Dodds WJ, Dent J, Hogan WJ, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982;307:1547.

    Article  CAS  PubMed  Google Scholar 

  7. Chowhan NM. Injurious effects of radiation on the esophagus. Am J Gastroenterol. 1990;85:115.

    CAS  PubMed  Google Scholar 

  8. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351:940.

    Article  CAS  PubMed  Google Scholar 

  9. Morales CP, Souza RF, Spechler SJ. Hallmarks of cancer progression in Barrett’s oesophagus. Lancet. 2002;360:1587.

    Article  PubMed  Google Scholar 

  10. Kubota K. From tumor biology to clinical PET: a review of positron emission tomography (PET) in oncology. Ann Nucl Med. 2001;15:471–486.

    Article  CAS  PubMed  Google Scholar 

  11. Sathekge M, Maes A, Van de Wiele C. FDG-PET imaging in HIV infection and tuberculosis. SeminNucl Med.. 2013;43:349–366.

    Google Scholar 

  12. Kouijzer IJ, Bleeker-Rovers CP, Oyen WJ. FDG-PET in fever of unknown origin. SeminNucl Med.. 2013;43:333–339.

    Google Scholar 

  13. Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics.. 1999;19:61–77.

    Article  CAS  PubMed  Google Scholar 

  14. Gordon BA, Flanagan FL, Dehdashti F. Whole body positron emission tomography: normal variations, pitfalls, and technical considerations. Am J Roentgeno.. 1997;169:1675–1680.

    Article  CAS  Google Scholar 

  15. Lowe VJ, Naunheim KS. Positron emission tomography in lung cancer. Ann Thorac Surg. 1998;65:1821.

    Article  CAS  PubMed  Google Scholar 

  16. Asad S, Aquino SL, Piyavisetpat N, Fischman AJ. False-positive FDG positron emission tomography uptake in nonmalignant chest abnormalities. Am J Roentgenol. 2004;182:983–989.

    Article  Google Scholar 

  17. Munden RF, Macapinlac HA, Erasmus JJ. Esophageal cancer: the role of integrated CT-PET in initial staging and response assessment after preoperative therapy. J Thorac Imaging. 2006;21:137–145.

    Article  PubMed  Google Scholar 

  18. Westerterp M, van Westreenen HL, Reitsma JB, et al. Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy—systematic review. Radiology. 2005;236:841–851.

    Article  PubMed  Google Scholar 

  19. Tatlidil R, Jadvar H, Bading JR, Conti PS. Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology. 2002;224:783–787.

    Article  PubMed  Google Scholar 

  20. Tsai MK, Ding HJ, Lai HC, Yen KY, Li CI, Lin YY, Cheng KY, Wang KB, Kao CH. Detection of gastroesophageal reflux esophagitis using 2-fluoro-2-deoxy-d-glucose positron emission tomography. Sci World J. 2012;702803.

  21. Salaun YS, Grewal RK, Dodamane I, Yeung HW, Larson SM, Strauss HW. An analysis of the 18F-FDG uptake pattern in the stomach. J Nucl Med. 2005;46:48–51.

    PubMed  Google Scholar 

  22. Kamel EM, Thumshirn M, Truninger K, et al. Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results. J Nucl Med. 2004;45:1804–1810.

    PubMed  Google Scholar 

  23. Roedl JB, Colen RR, King K, Fischman AJ, Mueller PR, Blake MA. Visual PET/CT scoring for nonspecific 18F-FDG uptake in the differentiation of early malignant and benign esophageal lesions. AJR Am J Roentgenol. 2008;191:515–521.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Swisher SG, Maish M, Erasmus JJ, et al. Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg. 2004;78:1152–1160.

    Article  PubMed  Google Scholar 

  26. Westreenen HL, Plukker JTM, Cobben DCP, Verhoogt CJM, Groen H, Jager PL. Prognostic value of the standardized uptake value in esophageal cancer. Am J Roentgenol. 2005;185:436–440.

    Article  Google Scholar 

  27. Flamen P, Lerut A, Van Cutsem E, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol. 2000;18:3202.

    CAS  PubMed  Google Scholar 

  28. Flanagan FL, Dehdashti F, Siegel BA, et al. Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. Am J Roentgenol. 1997;168:417.

    Article  CAS  Google Scholar 

  29. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82:228.

    CAS  PubMed  Google Scholar 

  30. Dent JB, Fendrick AM, Fennerty MB, et al. An evidence based appraisal of reflux disease management—the Genval Workshop Report. Gut. 1999;44:1–16.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9030, USA

    Joshua Stagg & Mohamed Kaif

  2. Department of Gastroenterology, Baylor Scott and White Temple, TX, 2401 South 31st Street, Temple, TX, 76508, USA

    Joshua Stagg

  3. Nuclear Medicine Service, Dallas Veterans Affairs Medical Center, 4500 South Lancaster Road, MC 115, Dallas, TX, 75216, USA

    Irfan Farukhi, Francisco Lazaga, Chiarra Thompson & Aron Gould-Simon

  4. Research Service, Dallas Veterans Affairs Medical Center, 4500 South Lancaster Road, MC 115, Dallas, TX, 75216, USA

    Ledjona Bradshaw

  5. Medical Service, Gastroenterology Section, Dallas Veterans Affairs Medical Center, 4500 South Lancaster Road, MC 111B1, Dallas, TX, 75216, USA

    Robert Schmidt

  6. 1105 26th Street S., Apt 203, Birmingham, AL, 35205, USA

    Mohamed Kaif

  7. 6121 N. Thesta St, Suite 207, Fresno, CA, 93710-8603, USA

    Aron Gould-Simon

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  1. Joshua Stagg
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Correspondence to Joshua Stagg.

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Stagg, J., Farukhi, I., Lazaga, F. et al. Significance of 18F-Fluorodeoxyglucose Uptake at the Gastroesophageal Junction: Comparison of PET to Esophagogastroduodenoscopy. Dig Dis Sci 60, 1335–1342 (2015). https://doi.org/10.1007/s10620-014-3456-0

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  • DOI: https://doi.org/10.1007/s10620-014-3456-0

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