title: F-18 FDG PET/CT contributes to more accurate detection of lymph nodal metastasis from actively proliferating esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  Evaluating the status of disease progression is critical for planning a therapeutic strategy for esophageal cancer. In this regard, F-18 fluorodeoxyglucose-labeled positron emission tomography (PET) is one of the most useful diagnostic modalities. However, there is room to improve its diagnostic performance, such as distinguishing lymph nodal metastases from false positives. In this study, we examined the diagnostic accuracy of fluorodeoxyglucose PET accompanied by computed tomography imaging (PET/CT) to detect regional lymph nodal metastasis from esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  A total of 102 patients diagnosed as ESCC were subjected to this study. These patients had a preoperative PET/CT examination to evaluate the existence of metastasis. The values of maximum standardized uptake value (SUVmax) in primary tumors and in metastasized lymph nodes were measured to analyze their relationship with various clinicopathologic characteristics including the status of tumor cell proliferation, which was assessed by immunohistochemistry for Ki-67.
  
  
  RESULTS
  The SUVmax of the primary tumor was positively correlated with tumor size and vessel invasion, and was positively related with the SUVmax of lymph nodal metastasis, especially in cases of poorly differentiated ESCC. The SUVmax of metastasized lymph nodes was higher in larger-sized metastasized lymph nodes, whereas the Ki-labeling index of lymph nodal metastasis was positively related with the SUVmax per unit area (SUVmax/mm). The diagnostic accuracy of PET/CT (87.3%) was higher than that of conventional CT scans (78.4%).
  
  
  CONCLUSIONS
  The improved diagnostic accuracy of PET/CT can be explained by its ability to detect actively progressive metastasis at an early phase regardless of size.
authors: Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
authors: Shunsuke
authors: S
authors: Tanabe
authors: Yoshio
authors: Y
authors: Naomoto
authors: Yasuhiro
authors: Y
authors: Shirakawa
authors: Yasuhiro
authors: Y
authors: Fujiwara
authors: Kazufumi
authors: K
authors: Sakurama
authors: Kazuhiro
authors: K
authors: Noma
authors: Munenori
authors: M
authors: Takaoka
authors: Tomoki
authors: T
authors: Yamatsuji
authors: Takao
authors: T
authors: Hiraki
authors: Yoshihiro
authors: Y
authors: Okumura
authors: Masahiko
authors: M
authors: Mitani
authors: Mitsumasa
authors: M
authors: Kaji
authors: Susumu
authors: S
authors: Kanazawa
authors: Toshiyoshi
authors: T
authors: Fujiwara
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D049109:Cell Proliferation; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18