Abstract
Background
We aimed to determine the appropriateness of adding 18F-fluorodeoxyglucose (FDG)-positronemission tomography (PET) to computed tomography (CT) and other pre-existing diagnostic imaging modalities for detecting subclinical lymph node metastasis of esophageal cancer, by comparing images from these modalities with the results of histopathological analysis.
Methods
Twenty patients who received radical surgery for squamous cell carcinoma of the esophagus were examined by PET-CT, and endoscopic ultrasound (EUS) examination before surgery. Based on these diagnostic modalities, the clinical target volume (CTV) was set as the gross tumor volume (GTV) plus a 1-cm margin. Histopathological diagnosis was performed in all patients immediately after resection.
Results
Fifty-three (3.0%) of 1764 nodes in the 20 patients were histopathologically positive for cancer cells. The CTV was not adequate to cover these histopathologically detected positive lymph nodes in 8 of 20 patients on CT, 5 of 20 on CT+EUS, 7 of 20 on PET-CT, and 5 of 20 on PET-CT+EUS.
Conclusion
The detection rate of subclinical lymph node metastasis did not improve with the use of PET-CT, for either the cervical and supraclavicular, mediastinal, or abdominal regions. It is not recommended to use FDG-PET or PET-CT alone as a diagnostic tool to determine CTV if pathologically involved lymphatic regions are to be included in the CTV in the treatment protocol. The accuracy of PET-CT must be further improved in order to better detect positive nodes and improve the definition of the CTV.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
Gao XS, Qiao X, Wu F, et al. (2007) Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma. Int J Radiat Oncol Biol Phys 67:389–396
Block MI, Patterson GA, Sundaresan RS, et al. (1997) Improvement in staging of esophageal cancer with the addition of positron emission tomography. Ann Thorac Surg 64:770–776
Luketich JD, Schauer PR, Meltzer CC, et al. (1997) Role of positron emission tomography in staging esophageal cancer. Ann Thorac Surg 64:765–769
Luketich JD, Friedman DM, Weigel TL, et al. (1999) Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg 68:1133–1136
Flanagan FL, Dehdashti F, Siegel BA, et al. (1997) Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 168:417–424
Flamen P, Lerut A, Van Cutsem E, et al. (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18: 3202–3210
Yoon YC, Lee KS, Shim YM, et al. (2003) Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection — prospective study. Radiology 227:764–770
Yuan S, Yu Y, Chao KS, et al. (2006) Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer. J Nucl Med 47:1255–1259
Blackstock AW, Farmer MR, Lovato J, et al. (2006) A prospective evaluation of the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography staging on survival for patients with locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys 64:455–460
Vrieze O, Haustermans K, De Wever W, et al. (2004) Is there a role for FDG-PET in radiotherapy planning in esophageal carcinoma ? Radiother Oncol 73:269–275
Moureau-Zabotto L, Touboul E, Lerouge D, et al. (2005) Impact of CT and 18F-deoxyglucose positron emission tomography image fusion for conformal radiotherapy in esophageal carcinoma. Int J Radiat Oncol Biol Phys 63:340–345
Gondi V, Bradley K, Mehta M, et al. (2007) Impact of hybrid fluorodeoxyglucose positron-emission tomography/computed tomography on radiotherapy planning in esophageal and non-small-cell lung cancer. Int J Radiat Oncol Biol Phys; 67:187–195
Sobin LH, Wittekind CH (2002) UICC: TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York
The Japanese Society for Esophageal disease (2001) Guidelines for clinical and pathologic studies on carcinoma of the esophagus, ninth edn. Kanehara, Tokyo, pp 8–10
Meltzer CC, Luketich JD, Friedman D, et al. (2000) Whole-body FDG positron emission tomographic imaging for staging esophageal cancer: comparison with computed tomography. Clin Nucl Med 25:882–887
Räsänen JV, Sihvo EIT, M. Knuuti MJ, et al. (2003) Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol 10:954–960
van Westreenen HL, Westerterp M, Bossuyt PMM, et al. (2004) Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22:3805–3812
Katsoulis IE, Wong WL, Mattheou AK, et al. (2007) Fluorine-18 fluorodeoxyglucose positron emission tomography in the preoperative staging of thoracic oesophageal and gastro-oesophageal junction cancer: a prospective study. Int J Surg 5:399–403
Leong T, Everitt C, Yuen K, et al. (2006) A prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Radiother Oncol 78:254–261
Shiga T, Morimoto Y, Kubo N, et al. (2009) A new PET scanner with semiconductor detectors enables better identification of intratumoral inhomogeneity. J Nucl Med 50:148–155
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Shimizu, S., Hosokawa, M., Itoh, K. et al. Can hybrid FDG-PET/CT detect subclinical lymph node metastasis of esophageal cancer appropriately and contribute to radiation treatment planning? A comparison of image-based and pathological findings. Int J Clin Oncol 14, 421–425 (2009). https://doi.org/10.1007/s10147-009-0893-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-009-0893-4