title: Incremental value of 18F-FDG PET/CT in therapeutic decision-making of potentially curable esophageal adenocarcinoma.
abstract: OBJECTIVE
  The aim of the study was to estimate the incremental value of fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) in aiding treatment decisions in a specific cohort of patients with lower esophageal and gastroesophageal junction adenocarcinoma who were considered for potentially curative treatment on the basis of conventional imaging.
  
  
  METHODS
  The study included patients referred for a staging F-FDG PET/CT who were considered for potentially curative treatment (neoadjuvant therapy followed by surgery or definitive chemoradiotherapy) by a multidisciplinary tumor board. The proportion of patients with M1b disease (American Joint Committee on Cancer, 6th ed.) detected on F-FDG PET/CT was calculated. The sensitivity, specificity, positive and negative predictive values, and accuracy of F-FDG PET/CT for M1b disease were calculated. PET/CT findings were verified with histopathological analysis; when it was not possible to obtain pathological confirmation, correlative imaging or follow-up imaging studies were used for validation.
  
  
  RESULTS
  A total of 156 patients who fulfilled the inclusion criteria were analyzed. F-FDG PET/CT detected M1b disease in 25 patients (16%), changing the intent of treatment from potentially curative to palliative. In five patients, PET/CT failed to detect distant metastases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-FDG PET/CT for detecting M1b disease were 83.3, 98.4, 92.5, 96.1, and 95.3%, respectively. Additional surgical procedures (hemicolectomy and polypectomy) were performed in three patients because of the detection of a second primary cancer in the colon in two patients and a colonic dysplastic polyp in one patient.
  
  
  CONCLUSIONS
  In patients who are considered to be potentially curable after conventional imaging, F-FDG PET/CT can detect unsuspected sites of distant metastases (M1b) in a significant number of cases and thus contribute to the clinical decision-making process. PET/CT should be an integral part of the staging workup of patients with esophageal adenocarcinoma.
authors.affiliation: Departments of aNuclear Medicine and Molecular Imaging bSurgical Oncology cRadiation Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Nilendu C
authors.initials: NC
authors.lastname: Purandare
authors.forename: C S
authors.initials: CS
authors.lastname: Pramesh
authors.forename: George
authors.initials: G
authors.lastname: Karimundackal
authors.forename: Sabita
authors.initials: S
authors.lastname: Jiwnani
authors.forename: Archi
authors.initials: A
authors.lastname: Agrawal
authors.forename: Sneha
authors.initials: S
authors.lastname: Shah
authors.forename: Mukta
authors.initials: M
authors.lastname: Kulkarni
authors.forename: Sarbani G
authors.initials: SG
authors.lastname: Laskar
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Rangarajan
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18