title: Preoperative positron emission tomography/computed tomography predicts advanced lymph node metastasis in esophageal squamous cell carcinoma patients.
abstract: BACKGROUND
  We aimed to study whether positron emission tomography/computed tomography (PET/CT) findings are associated with lymph node staging, as outlined by the 7th edition American Joint Committee on Cancer (AJCC) TNM staging system in patients with esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  A series of 76 ESCC patients undergoing esophagectomy were included in this study. The relation between PET/CT findings [maximum standardized uptake value (SUVmax)] and pathologic lymph node status (N stage) was studied.
  
  
  RESULTS
  The SUVmax of extra-tumor uptake, but not that of the main tumor, was significantly associated with the N classification. N2/N3 disease was observed in 61.1% of patients with an SUVmax for extra-tumor uptake of >4.9, whereas only 17.2% of patients with an SUVmax of extra-tumor uptake of <4.9 were classified as N2/N3 The number of PET abnormalities (NPAs) was also significantly associated with the N classification. Patients with three or more NPAs had a 65% chance of being classified as N2/N3, whereas patients with one or two NPAs had less than a 20% chance of being classified as N2/N3.
  
  
  CONCLUSIONS
  The SUVmax of extra-tumor uptake and the NPAs were significantly associated with the N classification outlined by the 7th edition of the AJCC TNM staging system. PET/CT does help identify patients with advanced lymph node metastasis (N2/N3 stage) instead of simply indicating nodal involvement.
authors.affiliation: Department of Surgery, Chutung Veterans Hospital, Chutung, Hsinchu, Taiwan. hsupokuei@yahoo.com.tw
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Hsu
authors.forename: Ko-Han
authors.initials: KH
authors.lastname: Lin
authors.forename: Shyh-Jen
authors.initials: SJ
authors.lastname: Wang
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Huang
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
mesh_terms: D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods