The utility of FDG PET/CT in investigating the imaging characteristics of esophageal cancer
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Abstract
Introduction: PET/CT is an effective modality in the diagnosis and monitoring esophageal cancer (EC). This study aimed to investigate the imaging characteristics of PET/CT with 2-deoxy-2-F18-fluoro-D-glucose (FDG) in patients with esophageal cancer.
Subjects and methods: A retrospective study described untreated primary EC patients who underwent FDG PET/CT imaging to investigate the imaging characteristics of lesions and assess the correlation between the metabolic activity of primary esophageal lesions and their invasiveness and metastasis.
Results: A total of 69 patients with esophageal cancer were included in the study, comprising 68 males and 1 female, with a mean age of 59,6 ± 7,5 (range 42-77). PET/CT identified all 76 primary esophageal lesions in these 69 patients. The most common locations of primary lesions were the mid-thoracic esophagus with 29/76 lesions (38,2%), while the least common was the abdominal esophagus with 2/76 lesions (2,6%). Cancers invading adjacent organs were observed in 14/76 lesions, including 5/76 lessions invading the trachea (6,6%), 4/76 lesions invading the thoracic aorta (5,3%) and 3/76 lesions invading the lungs (3,9%). The values for glucose metabolism in esophageal lesions included a maximum standardized uptake value (maxSUV) of 16,1±7,5, a peak standardized uptake value (peakSUV) of 12,6±6,1, a mean standardized uptake value (meanSUV) of 6,5±2,6, total lesion glycolysis (TLG) of 288,2±326,1, and metabolic tumor volume (MTV) of 41,1±41,6.
54/69 patients had regional lymph node metastases (78,3%). Common lymph node groups included upper paratracheal (10% of lymph nodes), upper thoracic paraesophageal (8,5% of lymph nodes) and cervical paraesophageal (8,5% of lymph nodes). The glucose metabolism values for metastatic lymph nodes were maxSUV=9,9±5,9.
PET/CT detected distant metastases in 23/69 patients (33,3%), including 11/69 patients with distant lymph node metastases (15.9%), 8/69 patients with bone metastases (11,6%), 5/69 patients with lung metastases (8,7%), and 1/69 patients with liver metastasis (1,4%) Among these cases, 3 patients had simultaneous metastases in two organs.
The metabolic tumor volume (MTV) was a significant predictor of invasion into adjacent organs (p<0,05) with an optimal cutoff value of MTV≥36,68 cm³ (sensitivity 71%, specificity 71%, AUC=0,73). Additionally, the cutoff value for total lesion glycolysis TLG≥132,26 (sensitivity 71%, specificity 76%, AUC=0,71) and primary esophageal tumor MTV≥17,47 cm³ (sensitivity 78%, specificity 65%, AUC=0,71) were significant predictors of regional lymph node metastasis (p<0,05).
Conclusion: Esophageal cancer lesions often exhibit increased glucose metabolism on FDG PET/CT imaging. PET/CT plays a crucial role in diagnosing primary lesion locations and detecting metastatic lesions. Glucose metabolic activity in esophageal cancer lesions correlates with the invasiveness of the lesions and the potential of regional lymph node metastasis.
Keywords: PET/CT, FDG, esophageal cancer.
Keywords
PET/CT, FDG, esophageal cancer
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References
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