title: Diagnostic accuracy of ¹⁸F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma.
abstract: OBJECTIVE
  To evaluate the role of (18)F-FDG PET/CT in the detection of recurrence in patients with oesophageal carcinoma, suspected clinically or following conventional investigations.
  
  
  METHODS
  This was a retrospective study. Data from 180 patients (age 56.3 ± 10.4 years; 126 men, 54 women) with histopathologically proven oesophageal carcinoma (squamous cell 115, adenocarcinoma 59, neuroendocrine carcinoma 4, small cell 1, poorly differentiated 1) who had undergone 227 (18)F-FDG PET/CT studies for suspected recurrence were analysed. Recurrence was suspected clinically or following conventional investigations. PET/CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local, nodal and distant recurrence. Results were compared to those from contrast-enhanced (CE) CT when available (109 patients). Clinical/imaging follow-up (minimum 6 months) with histopathology (when available) was taken as the reference standard.
  
  
  RESULTS
  Of the 227 (18)F-FDG PET/CT studies,166 were positive and 61 were negative for recurrent disease. PET/CT showed local recurrence in 134, nodal recurrence in 115 and distant recurrence in 47, with more than one site of recurrence in 34. The PET/CT findings were true-positive in 153 studies, true-negative in 54, false-positive in 13 and false-negative in 7. The sensitivity of (18)F-FDG PET/CT was 96%, the specificity was 81%, the positive and negative predictive values were 92% and 89%, respectively, and the accuracy was 91%. PET/CT showed similar accuracy in patients with squamous cell carcinoma and in those with adenocarcinoma (P = 0.181).(18)F-FDG PET/CT was more specific than CECT (67% vs. 21%; P < 0.0001). PET/CT was superior to CECT for the detection of nodal recurrence (P < 0.0001), but not local recurrence (P = 0.093) or distant metastases (P = 0.441).
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT shows high accuracy in the detection of suspected recurrence in patients with oesophageal carcinoma. It is more specific than and is superior to CECT in the detection of nodal recurrence.
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East) AIIMS Campus, New Delhi, 110029, India.
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
authors.forename: Sachin
authors.initials: S
authors.lastname: Jain
authors.forename: Sellam
authors.initials: S
authors.lastname: Karunanithi
authors.forename: Sujoy
authors.initials: S
authors.lastname: Pal
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Julka
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
authors.forename: Chandrasekhar
authors.initials: C
authors.lastname: Bal
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18