Patterns of Nodal Metastases on F-18-FDG PET/CT in Patients With Esophageal Squamous Cell Carcinoma are Useful to Guide Treatment Planning of Radiotherapy
Resource
Clin. Nucl. Med., 40(5), 384-389
Journal
Clin. Nucl. Med.
Journal Volume
40
Journal Issue
5
Pages
384-389
Date Issued
2015
Date
2015
Author(s)
Liu, Chia-Ju
Cheng, Jason Chia-Hsien
Lee, Jang-Ming
Cheng, Mei-Fang
Tzen, Kai-Yuan
Yen, Ruoh-Fang
Abstract
Background and Purposes: The aim of the study was to examine the patterns of lymph node metastases from esophageal squamous cell carcinoma (ESCC) and compare the laterality of lymphatic metastasis in cervical, supraclavicular, and paratracheal areas using F-18-FDG PET/CT. ;Patients and Methods: The data of 75 patients who underwent 18F-FDG PET/CT for staging of ESCC between January 2011 and March 2012 were reviewed. Fourteen groups of lymph nodes from the neck to abdomen were defined. Lateralization of the upper thoracic lymph nodes was defined in reference to the midline of the trachea. Frequencies of positive lymph nodes were used to determine the pattern of lymphatic spread and compare the lateralization of metastases in the cervical and upper thoracic regions. ;Results: The right paratracheal region was the most frequent site of metastasis among all patients. Left paratracheal and paragastric nodes were more frequent in upper and lower third ESCC, respectively. Upward and downward lymphatic spread was equal in mid third ESCC. In all patients, there was a trend toward more frequent lymph node metastasis on the right side than the left side for the supraclavicular and paratracheal regions. Further stratified analysis with tumor location found that right paratracheal node metastasis was significantly associated with mid third ESCC (P = 0.03). Remote nodal metastasis was found in 10.5% of patients with upper third ESCC and 13% of patients with lower third ESCC, respectively. Remote nodal metastasis was associated with higher SUV of the primary tumor (P = 0.02) and worse survival (P = 0.03). Receiver operating characteristic analysis showed a cutoff SUV of 14.8 for predicting remote lymph node metastases. ;Conclusions: PET/CT provides important information before radiotherapy planning. Mid and lower third ESCC tends to metastasize to the right paratracheal/supraclavicular lymph nodes. Remote nodal metastases on PET/CT correlated with higher primary tumor SUV and worse survival.
Subjects
esophageal cancer
FDG
PET/CT
lymph node metastasis
lymph node mapping
SDGs