Dept. of Nuclear Medicine, Army Hospital (R&R), Delhi Cantt, New Delhi, 110010
*Correspondence to: Dept. of Nuclear Medicine, Army Hospital (R&R), Delhi Cantt, New Delhi, 110010. Ph: 011-23338173, 23338171. Email: drssanand@gmail.com
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.
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.
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%)
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.
Esophageal Carcinoma, PET/CT
