title: FDG PET using SUVmaxfor preoperative T-staging of esophageal squamous cell carcinoma with and without neoadjuvant chemoradiotherapy.
abstract: Accurate T-staging is pivotal for predicting prognosis and selecting appropriate therapies for esophageal squamous cell carcinoma (ESCC). The diagnostic performance of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for its T-staging is uncertain. We investigated use of FDG PET/CT for preoperative T-staging of patients with ESCC.
  
  
  
  Patients with ESCC given preoperative FDG PET/CT scans, either with (CRT[+]group) or without (CRT[-]group) neoadjuvant chemoradiotherapy, were retrospectively reviewed. Maximal standardized uptake value (SUVmax) of the primary tumors on FDG PET/CT scans were measured, and histopathological results were used as the reference standard. The associations between pathological T-stage and potential factors of age, tumor location, tumor grade, tumor size, and tumor SUVmaxwere analyzed. The cut-off levels of SUVmaxfor predicting different T-stages and for residual viable tumors after neoadjuvant chemoradiotherapy were determined using receiver operating characteristic analyses.
  
  
  
  We enrolled 103 patients (45 in the CRT[-]group; 58 in the CRT[+]group). SUVmax, an independent predictive factor, positively correlated with the pathological T-stage in both groups (CRT[-]group: ρ = 0.736, p < 0.001; and CRT[+]group: ρ = 0.792, p < 0.001). The overall accuracy of the PET/CT with thresholded SUVmaxfor predicting the pathological T-stage was 73.3% in the CRT[-]group (SUVmaxof T0: 0-1.9, T1: 2.0-4.4, T2: 4.5-6.5, T3: 6.6-13.0, T4: >13.0) and 67.2% in the CRT[+]group (SUVmaxof T0: 0-3.4, T1: 3.5-3.9, T2: 4.0-5.5, T3: 5.6-6.2, T4: > 6.2). For CRT[-]group, the accuracy using an SUVmaxcut-off of 4.4 to differentiate early (T0-1) from locally advanced disease (T2-4) was 82.2% (95% CI, 71.1-93.4%). For CRT[+]group, the accuracy using an SUVmaxcut-off of 3.4 to predict residual viable tumors (non-T0) after completion of chemoradiotherapy was 82.8% (95% CI, 73.0-92.5%).
  
  
  
  The FDG avidity of a primary esophageal tumor significantly positively correlated with the pathological T-stage. PET/CT with thresholded SUVmaxwas useful for predicting T-stage and differentiating residual viable tumors.
authors.affiliation: Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yung-Cheng
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Lu
authors.affiliation: Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shun-Chen
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Nan-Tsing
authors.initials: NT
authors.lastname: Chiu
authors.affiliation: Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Wang
authors.affiliation: Department of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.affiliation: Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. lee0624@cgmh.org.tw.
authors.forename: Shau-Hsuan
authors.initials: SH
authors.lastname: Li
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Esophageal cancer; Neoadjuvant chemoradiotherapy; Positron emission tomography; Staging