Diagnostic value of surveillance 18F-fluorodeoxyglucose PET/CT for detecting recurrent esophageal carcinoma after curative treatment
- 314 Downloads
Esophageal carcinoma recurs within two years in approximately half of patients who receive curative treatment and is associated with poor survival. While 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a reliable method of detecting recurrent esophageal carcinoma, in most previous studies FDG PET/CT scans were performed when recurrence was suspected. The aim of this study was to evaluate FDG PET/CT as a surveillance modality to detect recurrence of esophageal carcinoma after curative treatment where clinical indications of recurrent disease are absent.
A total of 782 consecutive FDG PET/CT studies from 375 patients with esophageal carcinoma after definitive treatment were reviewed. Abnormal lesions suggestive of recurrence on PET/CT scans were then evaluated. Recurrence was determined by pathologic confirmation or other clinical evidence within two months of the scan. If no clinical evidence for recurrence was found at least 6 months after the scan, the case was considered a true negative for recurrence.
The diagnostic sensitivity and specificity of PET/CT for detecting recurrent esophageal carcinomas were 100% (64/64) and 94.0% (675/718), respectively. There were no significant differences in the diagnostic performance of PET/CT for detecting recurrence according to initial stage or time between PET/CT and curative treatments. Unexpected second primary cancers were detected by FDG PET/CT in seven patients.
Surveillance FDG PET/CT is a useful imaging tool for detection of early recurrence or clinically unsuspected early second primary cancer in patients with curatively treated esophageal carcinoma but without clinical suspicion of recurrence.
KeywordsEsophageal cancer Surveillance Nuclear medicine 18F-fluorodeoxyglucose PET/CT
This paper was supported by the following grant(s): The National R&D Program for Cancer Control, Ministry of Health & Welfare, Korea (1720180).
This study was funded by The National R & D Program for Cancer Control, Ministry of Health & Welfare, Korea (grant number 1720180).
Compliance with ethical standards
Conflict of interest
All authors declare they have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 3.Hamai Y, Hihara J, Emi M, Furukawa T, Ibuki Y, Yamakita I, et al. Treatment outcomes and prognostic factors after recurrence of esophageal squamous cell carcinoma. World J Surg. 2018;42(7):2190-2198. https://doi.org/10.1007/s00268-017-4430-8.
- 5.Schizas D, Lazaridis II, Moris D, Mastoraki A, Lazaridis LD, Tsilimigras DI, et al. The role of surgical treatment in isolated organ recurrence of esophageal cancer-a systematic review of the literature. World J Surg Oncol. 2018;16(1):55. https://doi.org/10.1186/s12957-018-1357-y.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198(2):205–11. https://doi.org/10.1016/j.jamcollsurg.2003.10.005.CrossRefPubMedGoogle Scholar
- 9.Lee SJ, Lee KS, Yim YJ, Kim TS, Shim YM, Kim K. Recurrence of squamous cell carcinoma of the oesophagus after curative surgery: rates and patterns on imaging studies correlated with tumour location and pathological stage. Clin Radiol. 2005;60(5):547–54. https://doi.org/10.1016/j.crad.2004.09.002.CrossRefPubMedGoogle Scholar
- 10.Goense L, van Rossum PS, Reitsma JB, Lam MG, Meijer GJ, van Vulpen M, et al. Diagnostic performance of (18)F-FDG PET and PET/CT for the detection of recurrent esophageal cancer after treatment with curative intent: a systematic review and meta-analysis. J Nucl Med. 2015;56(7):995–1002. https://doi.org/10.2967/jnumed.115.155580.CrossRefPubMedGoogle Scholar
- 15.Madu MF, Timmerman P, Wouters M, van der Hiel B, van der Hage JA, van Akkooi ACJ. PET/CT surveillance detects asymptomatic recurrences in stage IIIB and IIIC melanoma patients: a prospective cohort study. Melanoma Res. 2017;27(3):251–7. https://doi.org/10.1097/CMR.0000000000000347.CrossRefPubMedGoogle Scholar
- 17.Suh YS, Han DS, Kong SH, Lee HJ, Kim YT, Kim WH, et al. Should adenocarcinoma of the esophagogastric junction be classified as esophageal cancer? A comparative analysis according to the seventh AJCC TNM classification. Ann Surg. 2012;255(5):908–15. https://doi.org/10.1097/SLA.0b013e31824beb95.CrossRefPubMedGoogle Scholar
- 19.Betancourt Cuellar SL, Palacio DP, Wu CC, Carter BW, Correa AM, Hofstetter WL, et al. (18)FDG-PET/CT is useful in the follow-up of surgically treated patients with oesophageal adenocarcinoma. Br J Radiol. 2018;91(1082):20170341. https://doi.org/10.1259/bjr.20170341.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Lou F, Sima CS, Adusumilli PS, Bains MS, Sarkaria IS, Rusch VW, et al. Esophageal cancer recurrence patterns and implications for surveillance. J Thorac Oncol. 2013;8(12):1558–62. https://doi.org/10.1097/01.JTO.0000437420.38972.fb.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Yamaguchi T, Kato K, Nagashima K, Iwasa S, Honma Y, Takashima A, et al. Type of second primary malignancy after achieving complete response by definitive chemoradiation therapy in patients with esophageal squamous cell carcinoma. Int J Clin Oncol. 2018;23(4):652-658. https://doi.org/10.1007/s10147-018-1258-7.
- 25.Choi JY, Lee KS, Kwon OJ, Shim YM, Baek CH, Park K, et al. Improved detection of second primary cancer using integrated [18F] fluorodeoxyglucose positron emission tomography and computed tomography for initial tumor staging. J Clin Oncol. 2005;23(30):7654–9. https://doi.org/10.1200/JCO.2005.01.4340.CrossRefPubMedGoogle Scholar