Abstract
IntroductionWe evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT in the detection of hilar lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) to determine their value in guiding hilar lymph node staging and delineating radiation target volume.MethodsConsecutive patients with ESCC who underwent both PET/CT and contrast-enhanced CT before radical lymphadenectomy and esophagectomy at our institution from September 2009 to November 2018 were enrolled. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of FDG-PET/CT and contrast-enhanced CT for diagnosing hilar LNM were calculated.ResultsOf the 174 patients included, contrast-enhanced CT predicted nine positive cases, while PET/CT predicted one, and eight (4.6%) were identified as pathologically positive for their resected hilar lymph nodes. The SE, SP, PPV, and NPV of PET/CT and contrast-enhanced CT were 0.000, 0.994, 0.000, and 0.954; and 0.125, 0.952, 0.111, and 0.958, respectively. The specificity showed a significant difference (P=0.037). PET/CT is slightly more specific than contrast-enhanced CT.ConclusionsPET/CT and contrast-enhanced CT may be useful tools for predicting the negativity of hilar LN status, but they are not recommended for guiding the hilar lymph node staging and the delineating of hilar LNM in radiotherapy planning of ESCC patients based on their low PPV.
Highlights
We evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and contrastenhanced CT in the detection of hilar lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) to determine their value in guiding hilar lymph node staging and delineating radiation target volume
We conducted a retrospective study with a relatively larger patient cohort to explore the diagnostic performance of fluorodeoxyglucose Positron Emission Tomography (FDG-PET)/CT and contrast-enhanced CT for hilar LNM in patients with ESCC
Our results demonstrate that hilar LNM is a rare event in ESCC patients and both PET/CT and contrastenhanced CT are of limited value for diagnosis and delineation of hilar lymph nodes in radiotherapy
Summary
We evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and contrastenhanced CT in the detection of hilar lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) to determine their value in guiding hilar lymph node staging and delineating radiation target volume. Based on the operative pathology, LNM has been found to be involved in more than half of surgical patients in large-scale retrospective analyses [5, 6]. Among LN of ESCC, the incidence of hilar LNM is relatively low. In a retrospective analysis involving 1361 patients with thoracic ESCC who underwent curative esophagectomy, 52.5% (714/1361) were found to have LNM, while only 1% and 2.5% of patients experienced left and right hilar LNM, respectively [6]
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