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

T Hara, MD, PhD^a, O Kobori, MD, PhD^b, Y Kirihara, MD^b, N Kosaka, MD^a

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, .

For more information, contact ahara@kt.rim.or.jp

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.

http://www.cancerprev.org/Journal/Issues/26/101/1094/4441