Indian Journal of Nuclear Medicine
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Year : 2007  |  Volume : 22  |  Issue : 2  |  Page : 47-53

Clinical utility of FDG PET/CT in carcinoma esophagus

Dept. of Nuclear Medicine, Army Hospital (R&R), Delhi Cantt, New Delhi 110010, India

Correspondence Address:
S S Anand
Dept. of Nuclear Medicine, Army Hospital (R&R), Delhi Cantt, New Delhi 110010
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Source of Support: None, Conflict of Interest: None

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Background: A retrospective study was performed to evaluate the utility of integrated PET/CT in localization of primary disease, detection of nodal/distant metastases, detection of residual/recurrent disease after therapy and its ability to predict long term outcome in patients with esophageal carcinoma. Methods: 70 paients (38 males, 32 females, age group 32 to 78 years) with Carcinoma of esophagus/Gastro-esophageal junction (41 with squamous cell carcinoma and 29 with adenocarcinoma) were included in the study. 23 cases (Category 1) underwent 18F-FDG PET/CT as a part of pre-surgical staging work up. All these cases also underwent a baseline diagnostic CT of the thorax and upper abdomen, with oral and intravenous (IV) contrast. 20 of these cases underwent surgery (esophagectomy with gastric pull up) based on the PET/CT staging. Diagnostic validation was by histopathologic examination of resected specimen in the operated cases. Data was compiled and the incremental value of PET/CT over CECT for the detection of primary tumor and lymph node metastasis was assessed. The remaining 47 cases, underwent PET/CT as part of post-therapy follow up for detection of residual or recurrent disease; 18 cases (Category 2) were post-surgery (+/− chemotherapy/radiation therapy) and 29 cases (Category 3) came following conservative management (Chemotherapy/Radiotherapy/Chemo-radiotherapy) only. Data was compiled and value of PET/CT in detection of residual/recurrent disease after therapy and its ability to predict long term patient outcome was studied. Results: In category 1, PET/CT and CT showed concordant abnormality (locally active disease/nodal disease) in 7 cases. In 08 cases PET/CT showed positive uptake in normal sized nodes. In 03 cases CECT showed enlarged nodes which were non-FDG avid on PET/CT. In 03 cases PET/CT showed distant metastases which were not detected by CT. In category 2 recurrence at anastomotic site was detected in 1 case, disease recurrence along with distant metastases was seen in 2 cases and only residual nodal disease without a local disease was seen in 3 cases by PET/CT. Twelve cases were reported as disease free of which 10 were alive at one year (83% one year survival rate), whereas both the patients detected to have local recurrence and metastasis died within a year (one year survival rate - nil). In category 3, eight cases showed no residual disease and 21 showed metabolically active disease. Of the 08 cases shown as disease free by PET/CT, 07 survived over the next one-year period (One year survival rate 87.5%) Conclusion: In PET/CT, PET and CT provide complementary information and help in accurate staging, early detection of recurrence and prognostication in cases of Carcinoma Esophagus.

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