| Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer. | |
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MedLine Citation:
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PMID: 19205841 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess whether integrated fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can improve the diagnostic accuracy of metastatic regional lymph nodes (LNs) in esophageal cancer compared with contrast enhanced CT (CECT). METHODS: We examined 180 consecutive patients with esophageal cancer by integrated PET/CT between April 2006 and March 2007. Eighteen patients (M:F 14:4) underwent radical esophagectomy after evaluations by PET/CT and CECT of 5-7-mm-thick slices 70-80 s after injection. Regional LNs of esophageal cancer were retrospectively reviewed on CECT images by two blinded evaluators on the basis of the following cutoff sizes: 7 mm for all regional LNs (Protocol A), 10 mm for paratracheal LNs (Protocol B), and 7 mm for others. In addition, the maximum standardized uptake value (SUVmax) on PET/CT was evaluated for positive uptake by LNs. RESULTS: Of 210 LNs excised at surgery, 25 were positive and 185 were negative for metastasis at pathology. The PET/CT images identified 15 true-positive and 184 true-negative LNs, whereas CECT identified 15 true positives and 176 true negatives in Protocol A, and 14 true positives and 180 true negative in Protocol B. The sensitivity, specificity, accuracy, positive, and negative predictive values of PET/CT were respectively 60.0%, 99.5%, 94.8%, 93.8%, and 94.8%, whereas those of CECT were 60.0%, 95.1%, 91.0%, 62.5%, and 94.6% (Protocol A) and 56.0%, 97.3%, 92.4%, 73.7%, and 94.2% (Protocol B). A comparison of the two CECT protocols revealed fewer false-positive LNs in Protocol B, but slightly lower sensitivity in Protocol B than in Protocol A. Substantial numbers of false-positive LNs were determined by CECT in the paratracheal regions (6 of 9, 66.7%) and CECT revealed central necrosis in 4 of 15 (26.7%) true-positive LNs > 1.8 cm. The mean SUVmax on PET/CT was 2.9 (range 1.7-5.5) in true-positive LNs. The smallest LN metastasis detectable by PET/CT was 6 mm. CONCLUSIONS: Integrated PET/CT improves the PPV of regional LNs when compared with CECT. |
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Authors:
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Masahiro Okada; Takamichi Murakami; Seishi Kumano; Masatomo Kuwabara; Taro Shimono; Makoto Hosono; Hitoshi Shiozaki |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-02-11 |
Journal Detail:
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Title: Annals of nuclear medicine Volume: 23 ISSN: 0914-7187 ISO Abbreviation: Ann Nucl Med Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-02-11 Completed Date: 2009-04-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8913398 Medline TA: Ann Nucl Med Country: Japan |
Other Details:
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Languages: eng Pagination: 73-80 Citation Subset: IM |
Affiliation:
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Department of Radiology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Contrast Media / administration & dosage Esophageal Neoplasms / diagnosis*, surgery Female Fluorodeoxyglucose F18 / diagnostic use* Humans Injections, Intravenous Iopamidol / administration & dosage, diagnostic use* Lymph Nodes / radiography*, radionuclide imaging* Lymphatic Metastasis Male Middle Aged Neoplasm Staging Positron-Emission Tomography / methods* Radiopharmaceuticals / diagnostic use Reproducibility of Results Sensitivity and Specificity Subtraction Technique Systems Integration Tomography, X-Ray Computed / methods* |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 0/Radiopharmaceuticals; 62883-00-5/Iopamidol; 63503-12-8/Fluorodeoxyglucose F18 |
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