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Role of F18-FDG PET/CT in the Staging and Restaging of Esophageal Cancer: A Comparison with CECT

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Esophageal cancer is one of the most fatal cancers principally because of its late presentation. CECT plays an important role in the staging of esophageal cancer but has some limitations. PET/CT which provides physiological information along with anatomical information and is a whole body imaging technique may therefore be a better alternative and thereby can facilitate selection or exclusion of patients for resection. The aim was to evaluate the performance of F18 FDG PET/CT in the staging and restaging of esophageal carcinoma compared to CECT using histopathologic findings and clinical follow-up as gold standard. Twenty eight patients with proven esophageal carcinoma, both preoperative and postoperative, were studied with CECT and F18 FDG PET/CT scan within an interval of 2 weeks. The PET/CT scan was acquired after injection of 370 MBq (10 mCi) F18-FDG and was evaluated for areas of increased focal uptake. CECT scan of chest and abdomen was done after injection of iodinated non-ionic contrast media. CECT findings suggested stage-IV disease in 16/28 (57.14%) patients and non stage-IV disease in 12/28 (42.86%) patients, whereas PET/CT suggested stage-IV disease in 23/28 (82.14%) patients and non stage-IV disease in 5/28 (17.86%) patients. Total nine patients were upstaged by PET/CT compared to CECT, out of which 7 (25%) were correctly upstaged and 2 (7.14%) were falsely upstaged. PET/CT improved our ability to detect distant metastases in 25% of patients that was missed by CECT. So, the use of F18 FDG PET/CT in esophageal cancer can alter management in significant number of patients.

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References

  1. Boring CC, Squires TS, Tong T (1993) Cancer statistics, 1993. CA Cancer J Clin 43:7–26

    Article  PubMed  CAS  Google Scholar 

  2. Blot WJ, Devesea SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289

    Article  PubMed  CAS  Google Scholar 

  3. Schottenfeld D (1984) Epidemiology of cancer of the esophagus. Semin Oncol 11:92–100

    PubMed  CAS  Google Scholar 

  4. Schoenberg BS, Bailer JC, Fraumeni JF Jr (1971) Certain mortality patterns of esophageal cancer in the United States, 1930–67. J Natl Cancer Inst 46:63–73

    PubMed  CAS  Google Scholar 

  5. Aylomamitis A (1988) Epidemiology of cancer of the esophagus in Canada: 1931-1984. Gastroenterology 94:374–380

    Google Scholar 

  6. Kobori O, Kirihara Y, Kosaka N, Hara T (1999) Positron emission tomography of esophageal carcinoma using 11 C-choline and 18 F-fluorodeoxyglucose: a novel method of preoperative lymph node staging. Cancer 86:1638–1648

    Article  PubMed  CAS  Google Scholar 

  7. Flanagan FL, Dehdashti F, Siegel BA, Trash DD, Sundaresan SR, Pattersan GA et al (1997) Staging of esophageal cancer with F18-fluorodeoxyglucose positron emission tomography. Am J Roentgenol 168:417–424

    Article  CAS  Google Scholar 

  8. Roth JA, Pass HI, Flanagan MM, Graeber GM, Rosenberg JC, Steinberg S (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248

    PubMed  CAS  Google Scholar 

  9. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19:305–313

    PubMed  CAS  Google Scholar 

  10. Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  PubMed  CAS  Google Scholar 

  11. Bar-Shalom R, Valdivia AY, Blaufox MD (2000) PET imaging in oncology. Semin Nucl Med 30:150–185

    Article  PubMed  CAS  Google Scholar 

  12. May A, Ell C (2006) Diagnosis and treatment of early esophageal cancer. Curr Opin Gastroenterol 22:433–436

    Article  PubMed  Google Scholar 

  13. Pfau PR, Perlman SB, Stanko P, Frick TJ, Gopal DV, Said A et al (2007) The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography. Gastrointest Endosc 65:377–384

    Article  PubMed  Google Scholar 

  14. Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD et al (2007) Role of EUS. Gastrointest Endosc 66:425–434

    Article  PubMed  Google Scholar 

  15. Zhang X, Watson DI, Lally C, Bessell JR (2005) Endoscopic ultrasound for preoperative staging of esophageal carcinoma. Surg Endosc 19:1618–1621

    Article  PubMed  CAS  Google Scholar 

  16. Sun L, Su XH, Guan YS, Pan WM, Luo ZM, Wei JH et al (2009) Clinical usefulness of F18-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy. World J Gastroenterol 15(15):1836–1842

    Article  PubMed  Google Scholar 

  17. Roder JD, Busch R, Stein HJ, Fink U, Siewert JR (1994) Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus. Br J Surg 81:410–413

    Article  PubMed  CAS  Google Scholar 

  18. Choi JY, Lee KH, Shim YM, Lee KS, Kim JJ, Kim SE et al (2000) Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET. J Nucl Med 41:808–815

    PubMed  CAS  Google Scholar 

  19. Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, Van Raemdonck D (2001) Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies. Surg Oncol 10:113–122

    Article  PubMed  CAS  Google Scholar 

  20. Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP (2008) Prognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg 206:239–246

    Article  PubMed  Google Scholar 

  21. Wilson M, Rosato EL, Chojnacki KA, Chervoneva I, Kairys JC, Cohn HE (2008) Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res 146:11–15

    Article  PubMed  Google Scholar 

  22. Vilgrain V, Mompoint D, Palazzo L, Menu Y, Gayet B, Ollier P et al (1990) Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR l55:277–281

    Article  Google Scholar 

  23. Gore RM (2005) Upper gastrointestinal tract tumours: diagnosis and staging strategies. Cancer Imaging 5:95–98

    Article  PubMed  Google Scholar 

  24. Tio TL, Coene PP, Schouwink MH, Tytgat GN (1989) Esophagogastric carcinoma: preoperative TNM classification with endosonography. Radiology 173:411–417

    PubMed  CAS  Google Scholar 

  25. Massari M, Cioffi U, De Simone M, Lattuada E, Montorsi M, Segalin A et al (1997) Endoscopic ultrasonography for preoperative staging of esophageal carcinoma. Surg Laparosc Endosc 7:l62–l165

    Article  Google Scholar 

  26. Block MI, Patterson GA, Sundaresan RS, Bailey MS, Flanagan FL, Dehdashti F et al (1997) Improvement in staging of esophageal cancer with the addition of positron emission tomography. Ann Thorac Surg 64:770–776

    Article  PubMed  CAS  Google Scholar 

  27. Van Westreenen HL, Heeren PA, Jager PL, van Dullemen HM, Groen H, Plukker JT (2003) Pitfalls of positive findings in staging esophageal cancer with F18- fluorodeoxyglucose positron emission tomography. Ann Surg Oncol 10:1100–1105

    Article  PubMed  Google Scholar 

  28. Flamen P, Lerut A, Van Cutsem E, De Wever W, Peeters M, Stroobants S et al (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18:3202–3210

    PubMed  CAS  Google Scholar 

  29. Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter V, Plukker JT (2004) Detection of distant metastases in esophageal cancer with F18-FDG PET. J Nucl Med 45(6):980–987

    PubMed  Google Scholar 

  30. Okada M, Kumano Takamichi Murakami Seishi, Kuwabara M, Hosono Taro Shimono Makoto, Shiozaki H (2009) 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 23:73–80

    Article  PubMed  Google Scholar 

  31. Kato H, Miyazaki T, Nakajima M, Takita J, Kimura H (2005) The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer 103:148–156

    Article  PubMed  Google Scholar 

  32. Kato H, Miyazaki T, Nakajima M, Fukuchi M, Manda R, Kuwano H (2001) Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma. Br J Surg 91:1004–1009

    Article  Google Scholar 

  33. Salahudeen HM, Balan A, Naik K, Mirsadraee S, Scarsbrook AF (2008) Impact of the introduction of integrated PET-CT into the preoperative staging pathway of patients with potentially operable oesophageal carcinoma. Clin Radiol 63:765–773

    Article  PubMed  CAS  Google Scholar 

  34. Gillies RS, Middleton MR, Maynard ND, Bradley KM, Gleeson FV (2011) Additional benefit of F18-fluorodeoxyglucose integrated positron emission tomography/computed tomography in the staging of oesophageal cancer. Eur Radiol 21(2):274–280

    Article  PubMed  CAS  Google Scholar 

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No conflict of interest exists with reference to this manuscript. No competing financial interests exist.

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Authors and Affiliations

  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    Praveen Kumar, Nishikant A. Damle & Chandrasekhar Bal

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  1. Praveen Kumar
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  2. Nishikant A. Damle
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  3. Chandrasekhar Bal
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Correspondence to Nishikant A. Damle.

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Kumar, P., Damle, N.A. & Bal, C. Role of F18-FDG PET/CT in the Staging and Restaging of Esophageal Cancer: A Comparison with CECT. Indian J Surg Oncol 2, 343–350 (2011). https://doi.org/10.1007/s13193-012-0128-4

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  • DOI: https://doi.org/10.1007/s13193-012-0128-4

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