Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection prospective study.
OBJECTIVE
To prospectively compare the accuracy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) for detection of primary tumor and metastasis to individual lymph node groups and for nodal staging.


METHODS
From February 2000 to July 2001, 81 patients with squamous cell carcinoma of the esophagus (78 men and three women; age range, 31-90 years; mean age, 63 years) underwent CT and FDG PET before esophagectomy and lymph node dissection. During surgery, all visible and palpable lymph nodes in the surgical fields were removed. The accuracies of CT and FDG PET for depiction of metastasis to lymph nodes were compared.


RESULTS
For depiction of malignant nodal groups in each lymph node group, the sensitivity, specificity, and accuracy, respectively, of CT were 11% (11 of 96 nodal groups), 95% (553 of 581), and 83% (564 of 677), whereas those of FDG PET were 30% (29 of 96), 90% (525 of 581), and 82% (554 of 677) (P values: < .001, .009, and .382, respectively). Twenty-eight false-positive interpretations were rendered at CT in evaluations of 11 mediastinal, four hilar, and 13 abdominal nodal groups, and 56 false-positive interpretations were rendered at FDG PET in evaluations of 23 mediastinal, 32 hilar, and one abdominal nodal group.


CONCLUSIONS
FDG PET is more sensitive than CT for depicting nodal metastases in patients with squamous cell carcinoma of the esophagus. FDG PET is slightly less specific than CT for depicting metastases, but the difference in specificity between the two modalities is statistically significant. Both FDG PET and CT have low sensitivity for depicting nodal metastasis. The relatively low specificity of FDG PET for depiction of nodal metastasis compared with that of CT is caused mainly by a high rate of false-positive hilar node interpretations.
Yoon
Young Cheol
YC
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Lee
Kyung Soo
KS
Shim
Young Mog
YM
Kim
Byung-Tae
BT
Kim
Kwhanmien
K
Kim
Tae Sung
TS
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18