Lymph node staging of esophageal carcinoma by positron emission tomography using both C11-choline and F18-fluorodeoxyglucose

T Hara, MD, PhDa, O Kobori, MD, PhDb, Y Kirihara, MDb, N Kosaka, MDa

aDepartment of Radiology, bDepartment of Surgery, International Medical Center of Japan, Tokyo, Japan

AIM. It is desirable to have an accurate knowledge of lymph node metastases in determining the most appropriate treatment of esophageal carcinoma. Positron emission tomography (PET) using either C11-choline or F18-fluorodeoxyglucose (FDG) has been utilized to detect a variety of malignancies. The aim of this study is to determine the effectiveness of the combined use of these radio-tracers in detecting lymph node metastases in patients with esophageal carcinoma. METHODS. Lymph node metastases in 57 patients with biopsy-proven esophageal carcinoma (20 patients with T1 tumor and 37 patients with T2-4 tumor) were examined by PET using C11-choline and F18-FDG, and the effectiveness was correlated with pathologic findings after surgery. RESULTS. In detecting lymph node metastases in the mediastinum, C11-choline PET was superior to F18-FDG PET and computed tomography (CT), and detected very small metastases (5 mm in diameter). In detecting lymph node metastases in the upper abdomen, F18-FDG PET was superior to C11-choline PET (This showed a normal uptake in the liver) and CT, and detected lymph node metastases of more than 15 mm in diameter. When C11-choline PET and F18-FDG PET were used in combination, the effectiveness increased, and the overall sensitivity (=the proportion of the number of PET-positive lymph node stations (cervical, upper, middle, lower, and abdominal) to the number of all the pathologically positive lymph node stations (n=69)) was 83%. CONCLUSIONS. In this study, the combination of C11-choline PET and F18-FDG PET was very effective in evaluating the lymph node status of patients with esophageal carcinoma non-invasively.

KEY WORDS: esophageal cancer, metastasis, .

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Risk Assessment, Part 2.