PET-CT Versus EUS Lymph Node Detection in Esophageal Cancer Patients: Implications for Dilatation Requirement

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

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PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.084 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 144-144

Author(s):

Jasper Groen ◽

Suzanne Gisbertz ◽

Mark I Van Berge Henegouwen ◽

Annelijn E Slaman ◽

Sybren Meijer ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Predictive Value ◽

Neoadjuvant Chemoradiotherapy ◽

Celiac Trunk ◽

Pet Ct ◽

Resection Specimen ◽

Node Metastases ◽

18F Fdg

Abstract Background Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy. Methods All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated. Results A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%. Conclusion The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group. Disclosure All authors have declared no conflicts of interest.

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