title: Effectiveness of Repeat 18F-Fluorodeoxyglucose Positron Emission Tomography Computerized Tomography (PET-CT) Scan in Identifying Interval Metastases for Patients with Esophageal Cancer.
abstract: BACKGROUND
  An 18F-fluorodeoxyglucose positron emission tomography-computerized tomography (PET-CT) scan is performed after neoadjuvant chemoradiation (nCRT) to restage esophageal cancer. The purpose of this study was to determine the ability of PET-CT to accurately identify interval metastatic disease following nCRT.
  
  
  METHODS
  This was a single-institution retrospective review (January 2005-February 2012) of patients with esophageal cancer treated with nCRT who underwent pre- and post-nCRT PET-CT.
  
  
  RESULTS
  A total of 283 patients were treated with nCRT, of whom 258 (91.2%) had both a pre- and post-nCRT PET-CT. On the post-nCRT PET-CT, 64 patients (24.8%) had interval findings concerning for metastatic disease. Of these patients, only 10 (15.6%) had true-positive findings of metastatic disease (six biopsy proven). The sites of interval metastases included bone (4), liver (3), peritoneum (1), mediastinal lymph nodes (1), and cervical lymph nodes (1). The positive predictive value of post-nCRT PET-CT for interval metastases was 15.6% (10/64), and the yield for detecting metastases since the pre-nCRT PET-CT was 3.9% (10/258). The work-up of the 54 patients (20.9% of the initial starting group) with false-positive post-nCRT findings included biopsy (24.6%) and immediate additional imaging (45.2%). A total of 208 patients proceeded with surgery: 163 (78.4%) had no new findings on post-nCRT PET-CT, and 45 (21.6%) had new false-positive findings. False-positive sites mainly included the lung (15) and liver (14).
  
  
  CONCLUSIONS
  The yield of post-nCRT PET-CT for the detection of new metastatic disease was 3.9%. Post-nCRT PET-CT often leads to a high proportion of false positives and subsequent investigational work-up.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Emmanuel
authors.identifier: http://orcid.org/0000-0001-8570-4784
authors.initials: E
authors.lastname: Gabriel
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Raed
authors.initials: R
authors.lastname: Alnaji
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Du
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Moshim
authors.initials: M
authors.lastname: Kukar
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA. steven.hochwald@roswellpark.org.
authors.forename: Steven
authors.initials: S
authors.lastname: Hochwald
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18