Clinical usefulness of 18F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy.
OBJECTIVE
To evaluate the clinical usefulness of (18)F-fluorodeoxyglucose positron emission and computed tomography ((18)F-FDG PET/CT) in restaging of esophageal cancer after surgical resection and radiotherapy.


METHODS
Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans (three patients had two scans and one patient had three scans) for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after (18)F-FDG PET/CT examinations.


RESULTS
Tumor recurrence was confirmed histopathologically in seven of the 20 patients (35%) and by clinical and radiological follow-up in 13 (65%). (18)F-FDG PET/CT was positive in 14 patients (68.4%) and negative in six (31.6%). (18)F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of (18)F-FDG PET/CT was 85%, negative predictive value (NPV) was 100%, and positive predictive value (PPV) was 78.6%. The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes (n = 2) and anastomosis inflammation (n = 1). PET/CT demonstrated distant metastasis in 10 patients. (18)F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 (60%) patients after introducing (18)F-FDG PET/CT into their conventional post-treatment follow-up program.


CONCLUSIONS
Whole body (18)F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.
Department of Nuclear Medicine, the First Hospital of Xiamen, Fujian Medical University, Minnan PET Center, Xiamen, Fujian Province, China.
Long
L
Sun
Xin-Hui
XH
Su
Yong-Song
YS
Guan
Wei-Ming
WM
Pan
Zuo-Ming
ZM
Luo
Ji-Hong
JH
Wei
Long
L
Zhao
Hua
H
Wu
D000328:Adult; D000368:Aged; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000378:metabolism*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000706:statistics & numerical data*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18