Annals of Surgical Oncology

, Volume 24, Issue 6, pp 1739–1746 | Cite as

Effectiveness of Repeat 18F-Fluorodeoxyglucose Positron Emission Tomography Computerized Tomography (PET-CT) Scan in Identifying Interval Metastases for Patients with Esophageal Cancer

  • Emmanuel Gabriel
  • Raed Alnaji
  • William Du
  • Kristopher Attwood
  • Moshim Kukar
  • Steven Hochwald
Thoracic Oncology



An 18F-fluorodeoxyglucose positron emission tomography-computerized tomography (PET-CT) scan is performed after neoadjuvant chemoradiation (nCRT) to restage esophageal cancer. The purpose of this study was to determine the ability of PET-CT to accurately identify interval metastatic disease following nCRT.


This was a single-institution retrospective review (January 2005–February 2012) of patients with esophageal cancer treated with nCRT who underwent pre- and post-nCRT PET-CT.


A total of 283 patients were treated with nCRT, of whom 258 (91.2%) had both a pre- and post-nCRT PET-CT. On the post-nCRT PET-CT, 64 patients (24.8%) had interval findings concerning for metastatic disease. Of these patients, only 10 (15.6%) had true-positive findings of metastatic disease (six biopsy proven). The sites of interval metastases included bone (4), liver (3), peritoneum (1), mediastinal lymph nodes (1), and cervical lymph nodes (1). The positive predictive value of post-nCRT PET-CT for interval metastases was 15.6% (10/64), and the yield for detecting metastases since the pre-nCRT PET-CT was 3.9% (10/258). The work-up of the 54 patients (20.9% of the initial starting group) with false-positive post-nCRT findings included biopsy (24.6%) and immediate additional imaging (45.2%). A total of 208 patients proceeded with surgery: 163 (78.4%) had no new findings on post-nCRT PET-CT, and 45 (21.6%) had new false-positive findings. False-positive sites mainly included the lung (15) and liver (14).


The yield of post-nCRT PET-CT for the detection of new metastatic disease was 3.9%. Post-nCRT PET-CT often leads to a high proportion of false positives and subsequent investigational work-up.


Esophageal Cancer Positive Predictive Value National Comprehensive Cancer Network High Resolution Computerize Tomography Positron Emission Tomography Computerize Tomography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The statistical analysis was supported by Roswell Park Cancer Institute and National Cancer Institute Grant P30CA016056.


  1. 1.
    van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.CrossRefPubMedGoogle Scholar
  2. 2.
    National Comprehensive Cancer Network. Esophageal Cancer (Version 2.2016). Available at: Accessed 5 Sep 2016.
  3. 3.
    Ben-David K, Sarosi GA, Cendan JC, et al. Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies. Surg Endosc. 2012;26:162−67.CrossRefPubMedGoogle Scholar
  4. 4.
    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; discussion 1152−60.Google Scholar
  5. 5.
    You JJ, Wong RK, Darling G, et al. Clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the staging of patients with potentially resectable esophageal cancer. J Thorac Oncol. 2013;8:1563–69.CrossRefPubMedGoogle Scholar
  6. 6.
    Vomackova K, Neoral C, Aujesky R, et al. The benefit of PET/CT in the diagnosis and treatment of esophageal cancer. Rozhl Chir. 2015;94:8–16.PubMedGoogle Scholar
  7. 7.
    Kukar M, Alnaji RM, Jabi F, et al. Role of repeat 18F-fluorodeoxyglucose positron emission tomography examination in predicting pathologic response following neoadjuvant chemoradiotherapy for esophageal adenocarcinoma. JAMA Surg. 2015;150:555–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Vallbohmer D, Holscher AH, Dietlein M, et al. [18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg. 2009;250:888–94.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim MK, Ryu JS, Kim SB, et al. Value of complete metabolic response by (18)F-fluorodeoxyglucose-positron emission tomography in oesophageal cancer for prediction of pathologic response and survival after preoperative chemoradiotherapy. Eur J Cancer. 2007;43:1385-1391.CrossRefPubMedGoogle Scholar
  10. 10.
    Higuchi I, Yasuda T, Yano M, et al. Lack of fludeoxyglucose F 18 uptake in posttreatment positron emission tomography as a significant predictor of survival after subsequent surgery in multimodality treatment for patients with locally advanced esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2008;136:205-212.CrossRefPubMedGoogle Scholar
  11. 11.
    Elliott JA, O’Farrell NJ, King S, et al. Value of CT-PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status and survival in oesophageal adenocarcinoma. Br J Surg. 2014;101:1702–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Alnaji RM, Du W, Gabriel E, et al. Pathologic complete response is an independent predictor of improved survival following neoadjuvant chemoradiation for esophageal adenocarcinoma. J Gastrointest Surg. 2016;20:1541–46.CrossRefPubMedGoogle Scholar
  13. 13.
    Swisher SG, Erasmus J, Maish M, 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.CrossRefPubMedGoogle Scholar
  14. 14.
    Cervino AR, Pomerri F, Alfieri R, et al. 18F-fluorodeoxyglucose PET/computed tomography and risk stratification after neoadjuvant treatment in esophageal cancer patients. Nucl Med Commun. 2014;35:160–68.CrossRefPubMedGoogle Scholar
  15. 15.
    Piessen G, Petyt G, Duhamel A, et al. Ineffectiveness of (1)(8)F-fluorodeoxyglucose positron emission tomography in the evaluation of tumor response after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg. 2013;258:66–76.CrossRefPubMedGoogle Scholar
  16. 16.
    Malik V, Lucey JA, Duffy GJ, et al. Early repeated 18F-FDG PET scans during neoadjuvant chemoradiation fail to predict histopathologic response or survival benefit in adenocarcinoma of the esophagus. J Nucl Med. 2010;51:1863–69.CrossRefPubMedGoogle Scholar
  17. 17.
    Klaeser B, Nitzsche E, Schuller JC, et al. Limited predictive value of FDG-PET for response assessment in the preoperative treatment of esophageal cancer: results of a prospective multi-center trial (SAKK 75/02). Onkologie. 2009;32:724–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Palie O, Michel P, Menard JF, et al. The predictive value of treatment response using FDG PET performed on day 21 of chemoradiotherapy in patients with oesophageal squamous cell carcinoma. A prospective, multicentre study (RTEP3). Eur J Nucl Med Mol Imaging. 2013;40:1345–55.CrossRefPubMedGoogle Scholar
  19. 19.
    Duong CP, Hicks RJ, Weih L, et al. FDG-PET status following chemoradiotherapy provides high management impact and powerful prognostic stratification in oesophageal cancer. Eur J Nucl Med Mol Imaging. 2006;33:770–78.CrossRefPubMedGoogle Scholar
  20. 20.
    Bruzzi JF, Swisher SG, Truong MT, et al. Detection of interval distant metastases: clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy. Cancer. 2007;109:125–34.CrossRefPubMedGoogle Scholar
  21. 21.
    Stiekema J, Vermeulen D, Vegt E, et al. Detecting interval metastases and response assessment using 18F-FDG PET/CT after neoadjuvant chemoradiotherapy for esophageal cancer. Clin Nucl Med. 2014;39:862–67.CrossRefPubMedGoogle Scholar
  22. 22.
    Blom RL, Schreurs WM, Belgers HJ, et al. The value of post-neoadjuvant therapy PET-CT in the detection of interval metastases in esophageal carcinoma. Eur J Surg Oncol. 2011;37:774–78.CrossRefPubMedGoogle Scholar
  23. 23.
    Weber WA, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol. 2001;19:3058–65.CrossRefPubMedGoogle Scholar
  24. 24.
    Cerfolio RJ, Bryant AS, Ohja B, et al. The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg. 2005;129:1232–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Tahari AK, Chien D, Azadi JR, et al. Optimum lean body formulation for correction of standardized uptake value in PET imaging. J Nucl Med. 2014;55:1481-1484.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ghanem MA, Kazim NA, Elgazzar AH. Impact of obesity on nuclear medicine imaging. J Nucl Med Technol. 2011;39:40–50.CrossRefPubMedGoogle Scholar
  27. 27.
    Keramida G, Dunford A, Siddique M, et al. Relationships of body habitus and SUV indices with signal-to-noise ratio of hepatic (18)F-FDG PET. Eur J Radiol. 2016;85:1012–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Busing KA, Schonberg SO, Brade J, et al. Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT. Nucl Med Biol. 2013;40:206–13.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  1. 1.Department of Surgical OncologyRoswell Park Cancer InstituteBuffaloUSA
  2. 2.Department of BiostatisticsRoswell Park Cancer InstituteBuffaloUSA

Personalised recommendations