TY - JOUR
T1 - Prediction of occult lymph node metastasis by metabolic parameters in patients with clinically n0 esophageal squamous cell carcinoma
AU - Moon, Seung Hwan
AU - Kim, Ho Seong
AU - Hyun, Seung Hyup
AU - Choi, Yong Soo
AU - Zo, Jae Ill
AU - Shim, Young Mog
AU - Lee, Kyung Han
AU - Kim, Byung Tae
AU - Choi, Joon Young
PY - 2014/5/1
Y1 - 2014/5/1
N2 - The aim of this study was to investigate the value of 18F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. Methods: The study comprised 143 consecutive patients (mean age ± SD, 63.9 ± 8.6 y; range, 31.8-81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, 18F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. Results: Univariate analysis indicated that clinical T classification, SUVmax, SUVmean, MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2-4, SUVmax ≥ 4.8, SUVmean ≥ 3.2, MTV ≥ 5.5 cm3, TLG ≥ 220, and diameter ≥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7-12.4; P = 0.003) and SUVmax (HR, 3.5; 95% CI, 1.3-9.2; P 5 0.012) were independent risk factors. The combination of SUVmax and clinical T classification (HR, 13.2; 95% CI, 5.4-31.9; P < 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUVmax or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV max were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. Conclusion: SUVmax, combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus.
AB - The aim of this study was to investigate the value of 18F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. Methods: The study comprised 143 consecutive patients (mean age ± SD, 63.9 ± 8.6 y; range, 31.8-81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, 18F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. Results: Univariate analysis indicated that clinical T classification, SUVmax, SUVmean, MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2-4, SUVmax ≥ 4.8, SUVmean ≥ 3.2, MTV ≥ 5.5 cm3, TLG ≥ 220, and diameter ≥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7-12.4; P = 0.003) and SUVmax (HR, 3.5; 95% CI, 1.3-9.2; P 5 0.012) were independent risk factors. The combination of SUVmax and clinical T classification (HR, 13.2; 95% CI, 5.4-31.9; P < 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUVmax or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV max were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. Conclusion: SUVmax, combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus.
KW - Esophageal cancer
KW - Lymph node
KW - Occult metastasis
KW - PET/CT
UR - https://www.scopus.com/pages/publications/84901330849
U2 - 10.2967/jnumed.113.130716
DO - 10.2967/jnumed.113.130716
M3 - Article
C2 - 24700884
AN - SCOPUS:84901330849
SN - 0161-5505
VL - 55
SP - 743
EP - 748
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 5
ER -
