Introduction. The present study was conceived on a population of esophageal cancer patients (ECP) who have been undergoing FDG PET/CT and c.e.CT in a single session, both at initial staging and after more than 4 weeks from the end of neoadjuvant treatment. The prospective trial was approved by our institutional Ethical Committee. Herein, we reported the preliminary data about the comparison of diagnostic performance among PET/CT, c.e.CT and PET/c.e.CT. Materials and methods. The multidisciplinary team of our Institute started the recruitment from January 2012. To date, 60 ECP (46 male, 14 female, 62±12years) were recruited, with adenocarcinoma or squamous cell carcinoma who underwent basal PET/CT plus c.e.CT in a single session. The glycemic recorded value was not higher than 170mg/dL and insulin-dependent diabetic patients were excluded from recruitment, according to RECIST guideline. After 60min from the injection of 3MBq/Kg of FDG, a whole body PET/CT scan was acquired. At the end of standard acquisition, a neck-thorax-abdomen c.e.CT was performed; in particular three c.e. phases for the liver evaluation were made. Three specialized physicians (two radiologists and two nuclear medicine specialists) read the images, separately. The diagnostic performances of PET/CT, PET/c.e.CT and c.e.CT were evaluated by using the standard method and then compared with clinical staging (by patient-based analysis). Results. 60 patients performed both PET/CT and c.e.CT while 57 of them had all three scans. The imaging co-registration (PET and c.e.CT) was good in 88% of patients, discrete in 7% and scarce in only 5%. The agreement among the three scans was present in 35% of subjects. In the remnant 65% of patients, c.e.CT demonstrated more lymph node metastases than both PET/CT and PET/c.e.CT (15% and 11%, respectively), similarly PET/c.e.CT showed more loco-regional/distant lymph nodes and distant metastases than PET/CT (increase in positive rate=30%). The clinical staging was recovered in 28 (41%) patients. The positive predictive value of PET/c.e.CT was higher than PET/CT and c.e.CT for the identification of loco-regional/distant lymph nodes and distant metastases (81% vs. 78% and 70%, respectively). Conclusions. In ECP, at initial staging FDG PET/c.e.CT represents an accurate and feasible method for recognizing a major number of pathological findings in comparison with PET/CT and c.e.CT.
A prospective trial for the evaluation of esophageal cancer patients: fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) vs. contrast enhancement (c.e.) CT vs. FDG PET/c.e.CT
POMERRI, FABIO;
2013
Abstract
Introduction. The present study was conceived on a population of esophageal cancer patients (ECP) who have been undergoing FDG PET/CT and c.e.CT in a single session, both at initial staging and after more than 4 weeks from the end of neoadjuvant treatment. The prospective trial was approved by our institutional Ethical Committee. Herein, we reported the preliminary data about the comparison of diagnostic performance among PET/CT, c.e.CT and PET/c.e.CT. Materials and methods. The multidisciplinary team of our Institute started the recruitment from January 2012. To date, 60 ECP (46 male, 14 female, 62±12years) were recruited, with adenocarcinoma or squamous cell carcinoma who underwent basal PET/CT plus c.e.CT in a single session. The glycemic recorded value was not higher than 170mg/dL and insulin-dependent diabetic patients were excluded from recruitment, according to RECIST guideline. After 60min from the injection of 3MBq/Kg of FDG, a whole body PET/CT scan was acquired. At the end of standard acquisition, a neck-thorax-abdomen c.e.CT was performed; in particular three c.e. phases for the liver evaluation were made. Three specialized physicians (two radiologists and two nuclear medicine specialists) read the images, separately. The diagnostic performances of PET/CT, PET/c.e.CT and c.e.CT were evaluated by using the standard method and then compared with clinical staging (by patient-based analysis). Results. 60 patients performed both PET/CT and c.e.CT while 57 of them had all three scans. The imaging co-registration (PET and c.e.CT) was good in 88% of patients, discrete in 7% and scarce in only 5%. The agreement among the three scans was present in 35% of subjects. In the remnant 65% of patients, c.e.CT demonstrated more lymph node metastases than both PET/CT and PET/c.e.CT (15% and 11%, respectively), similarly PET/c.e.CT showed more loco-regional/distant lymph nodes and distant metastases than PET/CT (increase in positive rate=30%). The clinical staging was recovered in 28 (41%) patients. The positive predictive value of PET/c.e.CT was higher than PET/CT and c.e.CT for the identification of loco-regional/distant lymph nodes and distant metastases (81% vs. 78% and 70%, respectively). Conclusions. In ECP, at initial staging FDG PET/c.e.CT represents an accurate and feasible method for recognizing a major number of pathological findings in comparison with PET/CT and c.e.CT.
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