Abstract
Background18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%.ResultsOut of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10).ConclusionIn this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.
Highlights
18F-fluorodeoxyglucose positron emission tomography/magnetic reso‐ nance imaging (18F-FDG 18F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging (PET/MRI)) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail
Endoscopic ultrasound (EUS) may be performed for very localised tumours, and some gastro-oesophageal cancers may undergo a staging laparoscopy. (In our centre, staging laparoscopy is performed in patients with evidence of subdiaphragmatic disease who is eligible for curative surgical resection following fitness assessment and initial staging investigations.) There are limitations to this staging approach; 18F-FDG 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/computed tomography (CT)) has a high sensitivity for metastatic disease; diagnostic accuracy remains suboptimal for locoregional staging (Vliet et al 2008)
Participants Twenty-six participants with newly diagnosed oesophageal/gastro-oesophageal cancer were enrolled in this study
Summary
18F-fluorodeoxyglucose positron emission tomography/magnetic reso‐ nance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomog‐ raphy/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastrooesophageal cancer. Current clinical pathways incorporate contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging patients planned for curative surgery (Lordick et al 2016). (In our centre, staging laparoscopy is performed in patients with evidence of subdiaphragmatic disease who is eligible for curative surgical resection following fitness assessment and initial staging investigations.) There are limitations to this staging approach; 18F-FDG PET/CT has a high sensitivity for metastatic disease; diagnostic accuracy remains suboptimal for locoregional staging (Vliet et al 2008). EUS has a high performance for local staging, but may not be successful in up to 45% of patients (Kelly et al 2001)
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