title: Lymph node staging in esophageal adenocarcinoma with PET-CT based on a visual analysis and based on metabolic parameters.
abstract: BACKGROUND
  In order to investigate the value of FDG positron emission tomography-computed tomography (PET-CT), FDG PET (reviewed side-by-side with CT), and metabolic parameters in the assessment of lymph node status and prognosis.
  
  
  METHODS
  Fifty-five subjects with lymph node positive (N1) and 26 subjects with lymph node negative (N0) disease were included. In the slice with the maximum FDG uptake of the tumor, the axial area of the primary tumor, the maximum diameter of the tumor, and the mean and maximum standardized uptake values were measured.
  
  
  RESULTS
  Fused PET-CT correctly characterized 289 of 325 lymph node groups (accuracy 89%) compared to 273 of 325 with PET (accuracy 84%). In lymph node staging (N0 vs. N1), PET-CT (accuracy 83%) was more accurate than PET (accuracy 78%). Among the metabolic parameters, the tumor diameter measured on PET-CT was the best predictor of lymph node stage (N0 vs. N1: accuracy 86%; threshold 25.5 mm) and overall survival. However, the highest accuracy of lymph node staging (N0 vs. N1) was achieved with the synergistic combination of visual analysis and primary tumor diameter measurements (accuracy 95%).
  
  
  CONCLUSIONS
  PET-CT increases accuracy of lymph node staging in esophageal adenocarcinoma compared to PET. The primary tumor diameter further improves accuracy in lymph node staging and was shown to be an independent predictor of overall survival.
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA. johannes.roedl@gmail.com
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Roedl
authors.forename: Michael A
authors.initials: MA
authors.lastname: Blake
authors.forename: Nagaraj S
authors.initials: NS
authors.lastname: Holalkere
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
authors.forename: Rivka R
authors.initials: RR
authors.lastname: Colen
authors.forename: Mukesh G
authors.initials: MG
authors.lastname: Harisinghani
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014055:Tomography, Emission-Computed / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18