Comparison of gross tumor volume delineated by anatomic imaging and FDG PET/CT for esophageal carcinoma and validation with pathological specimen

15090 Background: Although results of clinical studies have demonstrated FDG PET/CT improved target volume delineation in various tumors, only few studies compared delineation based on PET/CT with pathologic examination. Aim of our study was to compare anatomic imaging modalities including computed tomography (CT), esophagram, endoscopy with FDG PET/CT for delineation of gross tumor volume (GTV) in esophageal carcinoma and to validate the results with the pathologic examination. Methods: Thirty patients with stages II-III squamous cell carcinoma underwent transthoracic esophagectomy were enrolled. PET/CT, esophagram and endoscopy were performed with patients before operations. The length of the lesion on the PET/CT scan and on the CT portion of the PET/CT and the PET scan alone was determined independently by 3 separate investigative groups. PET/CT scan was evaluated by visual inspection for abnormality. A standard uptake value (SUV) of 2.5 was used in the PET scan to delineate the tumor extent. The lengths of GTVs determined with the five modalities (PET/CT, PET, CT, esophagram and endoscopy) were compared quantitatively and validated with the pathologic specimen. The sizes of the tumors were measured by pathologic examination which was considered as the gold standard. Results: Of the 30 patients, 9 had T2 tumors, 20 had T3 tumors and 1 had T4 tumor with an involvement of pleura. Three tumors were located at the upper esophagus, 14 at the middle esophagus, 13 at the lower esophagus. The mean length of the carcinoma was 5.85cm(SD 2.50cm) measured by pathologic examination, 5.79cm (SD 2.04cm) as determined by PET scan, 5.14cm (SD 1.65cm) by PET/CT scan, 5.42 cm(SD 2.42cm)by CT scan, 5.50cm(SD 2.79cm) by endoscopy, and 6.07cm(SD 2.75cm) by esophagram respectively. Although the lengths of the tumors as measured by the five imaging modalities were no significant difference, the result of PET was the most accurate. Conclusions: Compared with tumor lengths measured by pathologic examination, PET with a SUV 2.5 was found to be the most accurate modality and can help the radiation oncologist delineate the GTV of esophageal carcinoma precisely. No significant financial relationships to disclose.