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Original Articles: General Thoracic

Positron Emission Tomography–Computed Tomography in Predicting Locoregional Invasion in Esophageal Squamous Cell Carcinoma

^a Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan
^b Taipei Medical University School of Medicine, Taipei, Taiwan
^c Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
^d Department of Nuclear Medicine, Taipei-Veterans General Hospital, Taipei, Taiwan

Accepted for publication February 23, 2009.

^_* Address correspondence to Dr Wen-Hu Hsu, Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan (Email: whhsu{at}vghtpe.gov.tw).

Background: In order to clarify the role of positron emission tomography–computed tomography (PET/CT) in thoracic esophageal squamous cell carcinoma we investigated its value in predicting locoregional invasion.

Methods: Forty-five patients receiving curative esophagectomy and lymph node dissection were included. The relationship between PET/CT findings and pathology results were studied. Correlation between nodal uptake and the modified lymph node staging, which is based on number of involved nodes (N0 = no nodes; N1 = 1 to 3 nodes; N2 = more than 3 nodes), was evaluated.

Results: The mean maximal standardized uptake value (SUV_max) was 5.09 ± 4.00 in T1, 14.17 ± 2.46 in T2, 13.32 ± 3.96 in T3, and 10.37 ± 1.94 in T4 primary tumor. The SUV_max was significantly lower in stage T1 tumors than in stage T2 and T3 tumors. For regional nodal involvement, PET/CT findings significantly correlated with pathology results. However, the sensitivity, specificity, and accuracy of PET/CT were only 57.1%, 83.3%, and 71.1%, respectively, and even lower for detecting nonregional lymph node metastasis. When stratified by the modified staging system, the mean SUV_max was 0.64 ± 1.60 in N0, 1.43 ± 2.08 in N1, and 4.67 ± 4.32 in N2 regional lymph node metastases, and was significantly higher in patients with N2 metastasis than in patients with N0 and N1 metastases.

Conclusions: Locoregional invasion in esophageal cancer can be predicted by PET/CT. The SUV_max of the primary tumor helped identify T1 tumor, and the SUV_max of the regional lymph nodes correlated with the severity of nodal involvement.