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Ohsawa M, Hamai Y, Emi M, Ibuki Y, Kurokawa T, Yoshikawa T, Hirohata R, Kitasaki N, Okada M. Association between prognosis and lymph node status using 18F-fluorodeoxyglucose-positron emission tomography in esophageal squamous cell carcinoma treated with esophagectomy post-neoadjuvant chemotherapy. World J Surg 2024; 48:650-661. [PMID: 38686781 DOI: 10.1002/wjs.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND There are few reports on the associations between lymph node (LN) status, determined by preoperative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), and prognosis in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy post-neoadjuvant chemotherapy (NCT). Additionally, details on the diagnostic performance of LN metastasis determination based on pathological examination versus FDG-PET have not been reported. In this study, we aimed to evaluate the associations among LN status using FDG-PET, LN status based on pathological examination, and prognosis in patients with locally advanced ESCC who underwent esophagectomy post-NCT. METHODS We reviewed the data of 124 consecutive patients with ESCC who underwent esophagectomy with R0 resection post-NCT between December 2008 and August 2022 and were evaluated pre- and post-NCT using FDG-PET. The associations among LN status using FDG-PET, LN status based on pathological examination, and prognosis were assessed. RESULTS Station-by-station analysis of PET-positive LNs pre- and post-NCT correlated significantly with pathological LN metastases (sensitivity, specificity, and accuracy pre- and post-NCT: 51.6%, 96.0%, and 92.1%; and 28.2%, 99.5%, and 93.1%, respectively; both p < 0.0001). Using univariate and multivariate analyses, LN status determined using PET post-NCT was a significant independent predictor of both recurrence-free survival and overall survival. CONCLUSION The LN status assessed using FDG-PET post-NCT was significantly associated with the pathological LN status and prognosis in patients with ESCC who underwent esophagectomy post-NCT. Therefore, FDG-PET is a useful diagnostic tool for preoperatively predicting pathological LN metastasis and survival in these patients and could provide valuable information for selecting individualized treatment strategies.
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Affiliation(s)
- Manato Ohsawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoichi Hamai
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Manabu Emi
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Kurokawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Toru Yoshikawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Hirohata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Nao Kitasaki
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Liao S, Wei W, Zhang S, Zeng T, Chen H, Zheng W, Chen C, Ji Z, Zheng B. Modified method to improve the diagnostic efficiency of 18F-FDG PET/CT in regional lymph node metastasis of esophageal squamous cell carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1549. [PMID: 34790755 PMCID: PMC8576671 DOI: 10.21037/atm-21-4926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
Background Regional lymph node (LN) metastasis is a significant factor influencing the treatment choice of esophageal squamous cell carcinoma (ESCC). The performance PET/CT as an imaging evaluation method for regional LNs in ESCC, is unsatisfactory due to the lack of logical criterion. We explored how a modified criterion improved the diagnostic value of 18F-FDG PET/CT in regional LN metastasis. Methods The data from 111 patients with ESCC were analyzed retrospectively. All patients underwent preoperative PET/CT examination, resection of the cancer, and regional LN dissection. The PET/CT images were interpreted by two experienced diagnosticians. LNs were allocated to five subregions. Each LN was diagnosed by two diagnostic criteria of PET/CT (traditional criterion and the modified criterion) one by one across the same field, and the accuracy of PET/CT was determined using the histopathologic results as the reference standard. Results A total of 4,847 LNs were dissected, of which 147 were confirmed as metastases by postoperative pathology. A total of 656 LNs were screened by 18F-FDG PET/CT imaging. The determination of all 656 LNs by PET/CT was compared with the pathological results. The diagnostic accuracy of the modified and traditional criteria for the five subregions (paraesophageal, neck, upper mediastinal, middle-lower mediastinal and ventral subregions) was: 74.60% vs. 61.90%, 86.44% vs. 81.36%, 90.26% vs. 70.78%, 96.19% vs. 75.09%, and 87.91% vs. 85.71%, respectively. Conclusions The modified diagnostic criterion had better diagnostic efficiency because it combined PET and CT imaging data.
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Affiliation(s)
- Siqin Liao
- PET/CT Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenwei Wei
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shuliang Zhang
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Taidui Zeng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hao Chen
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chun Chen
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhongyou Ji
- PET/CT Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou, China
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Chen YH, Lu HI, Lo CM, Wang YM, Chou SY, Hsiao CC, Li SH. The Clinical Outcomes of Locally Advanced Cervical Esophageal Squamous Cell Carcinoma Patients Receiving Curative Concurrent Chemoradiotherapy: A Population-Based Propensity Score-Matched Analysis. Cancers (Basel) 2019; 11:cancers11040451. [PMID: 30934987 PMCID: PMC6520767 DOI: 10.3390/cancers11040451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022] Open
Abstract
This study investigated the clinical outcome of locally advanced cervical esophageal squamous cell carcinoma (ESCC) patients who received curative concurrent chemoradiotherapy (CCRT) and their differences from thoracic ESCC patients. Among 411 enrolled ESCC patients, including 63 with cervical and 348 with thoracic ESCC, 63 thoracic patients were propensity score-matched to the 63 cervical patients. For cervical ESCC, T4b and high tumor grade were independent prognostic factors of a worse overall survival (OS) in univariate and multivariate analyses. The response rates to curative CCRT between cervical and the matched thoracic ESCC groups were similar but cervical ESCC had a better OS than that of the matched thoracic group (21.4 versus 10.1 months, p = 0.012). Better OS was mentioned to be in the patients with complete response (CR), whether in the cervical or matched thoracic ESCC group. For patients without CR, patients who underwent esophagectomy had superior OS than those without operation in the matched thoracic ESCC group (11.6 versus 11.9 months, p = 0.73). Only three patients received operation in the cervical ESCC group, thus the survival difference was not significant. Curative CCRT may be a reasonable treatment for cervical ESCC in clinical practice, and the role of surgery should be considered as salvage therapy if residual disease is evident.
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Affiliation(s)
- Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Shang-Yu Chou
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
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Comparative accuracy of qualitative and quantitative 18F-FDG PET/CT analysis in detection of lymph node metastasis from anal cancer. Abdom Radiol (NY) 2019; 44:828-835. [PMID: 30694369 DOI: 10.1007/s00261-019-01907-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the diagnostic performance of qualitative and quantitative 18F-FDG PET/CT in detection of regional and distant lymph node metastasis in patients with anal cancer. METHODS Between 2004 and 2017, 28 patients with anal cancer who had staging PET/CT and pathological assessment of suspicious lymph nodes were included. For qualitative analysis, positive lymph nodes were defined as uptake visually higher than the liver reference uptake. For quantitative study, lymph nodes were contoured to determine maximum standard uptake value (SUVmax) and metabolic tumor volume (MTV). Receiver operating characteristic (ROC) curves were plotted to extract the optimal cut-offs and area under the curve (AUC) of SUVmax, lesion to background (L/B) ratio, short axis diameter (SAD), and MTV of lymph nodes. Histopathologic analysis was a reference standard. RESULTS A total of 28 lymph nodes (24 inguinal, 2 external iliac, 1 internal iliac, and 1 paraaortic nodes) in 28 patients on PET/CT were included. With the qualitative visual analysis, 19 patients were categorized as positive for nodal metastasis with sensitivity, specificity, and accuracy of 85%, 75%, and 82%. The optimal SUVmax and L/B ratio cut-offs were 2.6 and 1.0 with both sensitivity and specificity of 95% and 75% (AUC of SUVmax = 0.893, AUC of L/B ratio = 0.912). Using the best cut-off of 1.6 cm for SAD and 3.65 cm3 for MTV, both sensitivity and specificity were 80% and 100% (AUC of SAD = 0.950, AUC of MTV = 0.931). CONCLUSIONS SUVmax optimization may be helpful in enhancing the diagnostic accuracy of 18F-FDG PET/CT in nodal staging patients with anal cancer.
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Jiang C, Chen Y, Zhu Y, Xu Y. Systematic review and meta-analysis of the accuracy of 18F-FDG PET/CT for detection of regional lymph node metastasis in esophageal squamous cell carcinoma. J Thorac Dis 2018; 10:6066-6076. [PMID: 30622778 DOI: 10.21037/jtd.2018.10.57] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background We performed a systematic review and meta-analysis to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography with computer tomography (18F-FDG PET/CT) for detection of regional lymph node metastasis in esophageal squamous cell carcinoma in per-patient and per-nodal station basis. Methods Electronic databases were researched for studies assessing the sensitivity and specificity of PET/CT to detect the regional lymph node metastasis published between January 2006 and December 2017 on esophageal squamous cell carcinoma. STATA software was performed to assess the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd ratio (DOR) and summary receiver operating characteristic (SROC) curve. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Deeks' Funnel Plot Asymmetry Test were performed to evaluate the study quality and publication bias of included studies. Results Nineteen studies were eligible for meta-analysis, comprising 1,089 patients with esophageal cancer who underwent 18F-FDG PET/CT before surgery. According to the content of the article, we divided the selected studies into per-patient basis group and per-nodal basis group (one of the articles was involved in both groups). For the per-nodal station basis group (12 studies, 5,681 stations), the pooled sensitivity and specificity estimates of 18F-FDG PET/CT for detecting regional lymph node metastasis were 66% [95% confidence interval (CI): 51-78%] and 96% (95% CI: 92-98%), respectively. The corresponding values on a per-patient basis group (8 studies; 506 patients) were 65% (95% CI: 49-78%) and 81% (95% CI: 69-89%) in sensitivity and specificity, respectively. Conclusions Overall, 18F-FDG PET/CT have a moderate to low sensitivity and a high to moderate specificity for detection of regional nodal metastasis in esophageal cancer. Therefore, since the false rate is considerable, extending the extent of lymph node dissection or radiotherapy target volume is necessary after diagnosis of regional nodal metastasis by 18F-FDG PET/CT.
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Affiliation(s)
- Chenxue Jiang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yun Chen
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yaoyao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yapping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Neck Lymph Node Metastasis as A Poor Prognostic Factor in Thoracic Esophageal Squamous Cell Carcinoma Patients Receiving Concurrent Chemoradiotherapy: A Propensity Score-Matched Analysis. Sci Rep 2018; 8:15073. [PMID: 30305678 PMCID: PMC6180063 DOI: 10.1038/s41598-018-33400-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/28/2018] [Indexed: 12/23/2022] Open
Abstract
The present study investigated the clinical impact of neck lymph node (LN) metastasis in locally advanced inoperable thoracic esophageal squamous cell carcinoma (ESCC) patients who underwent concurrent chemoradiotherapy (CCRT) with a curative intent. There were 404 ESCC patients enrolled, including 35 patients with neck LN metastasis and 369 patients without such metastasis. Through the propensity score matching method, 35 patients of the 369 patients without neck LN metastasis were matched to the 35 patients with neck LN metastasis. Progression-free survival (PFS) and overall survival (OS) were found to be significantly worse in the neck LN metastasis group compared to the full non-neck LN metastasis group (9.8 months versus 5.9 months, P < 0.001, and 18.2 months versus 9.7 months, P = 0.001) and the matched non-neck LN metastasis group (9.9 months versus 5.9 months, P = 0.006, and 19.4 months versus 9.7 months, P = 0.007). In order to determine the difference between neck LN and supraclavicular LN metastasis, seventy patients with supraclavicular LN metastasis were also selected from the 369 patients without neck LN metastasis for comparison. Subsequently, when compared to the ESCC patients with supraclavicular LN metastasis, significantly worse PFS (8.5 months versus 5.9 months, P = 0.026) and OS (17.2 months versus 9.7 months, P = 0.047) were still found in the ESCC patients with neck LN metastasis. Our study indicates that neck LN metastasis is an independent poor prognostic factor for locally advanced inoperable thoracic ESCC patients who have undergone CCRT.
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Wang Y, Zhang L, Ye D, Xia W, Jiang J, Wang X, Zhang M, Wang F. A retrospective study of pattern of recurrence after radical surgery for thoracic esophageal carcinoma with or without postoperative radiotherapy. Oncol Lett 2018; 15:4033-4039. [PMID: 29556283 DOI: 10.3892/ol.2018.7807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/11/2018] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to investigate the recurrence pattern of thoracic esophageal cancer (TEC) following radical surgery for guiding postoperative radiotherapy (PRT). Patterns of recurrence were analyzed in patients with recurrence for the first time after radical surgery at the First Affiliated Hospital of Anhui Medical University (Anhui, China) from January 2012 to December 2015. A total of 244 patients were reviewed in the study. The mean recurrence time for patients with PRT was >1 month longer than that for patients without PRT. The lymphatic, anastomotic and hematological recurrence ratios were 87.9 vs. 69.2%, 4.0 vs. 11.5% and 8.0 vs. 17.2%, respectively for patients without and with PRT. The most common recurrence regions were staion1 and station 2-4 (30.0 vs. 36.5% and 37.2% vs. 23.1%, respectively, for patients without and with PRT). The lymphatic recurrence of upper TEC was almost in station1 and station 2-4 (infield). The middle and lower TEC also had a high probability of lymphatic recurrence in station 1 and station 2-4 (totally 76.3 vs. 57.6% and 61.9 vs. 61.1%, respectively). The recurrence ratio significantly decreased in station 2-4 (infield) for middle TEC patients with PRT compared with patients without PRT (P=0.03), while no significant differences in the lymphatic recurrence ratios were observed in other regions (P>0.05). The differences of recurrence ratios in station 7, station 8 and celiac regions (infield) for lower TEC patients without and with PRT also demonstrated no statistical significance (P>0.05). The results of the present study indicated that the lower neck, supraclavicular regions and upper mediastinal regions (station 1, 2 and 4) should be included in the clinic target volume (CTV) for PRT, while lower mediastinal regions, celiac regions and anastomotic may not be included in CTV.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Li Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Dongmei Ye
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wanli Xia
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Jun Jiang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Xiumei Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Mingxia Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Ding RL, Cao HY, Hu Y, Shang CL, Xie F, Zhang ZH, Wen QL. Lymph node tuberculosis mimicking malignancy on 18F-FDG PET/CT in two patients: A case report. Exp Ther Med 2017; 13:3369-3373. [PMID: 28587415 PMCID: PMC5450601 DOI: 10.3892/etm.2017.4421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/23/2016] [Indexed: 01/06/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) imaging, an established procedure for evaluation of malignancy, reports an increased 18F-FDG uptake in acute or chronic inflammatory condition. Lymph node tuberculosis (LNTB) is the most common form of extrapulmonary tuberculosis. However, the absence of clinical symptoms and bacteriological basis makes it difficult to diagnose. In the current case report, two patients with LNTB mimicking malignant lymphoma are presented by 18F-FDG PET/CT. The objective of the present report is to emphasize that LNTB should be considered as a noteworthy differential diagnosis in patients with enlarged lymph nodes, particularly in tuberculosis-endemic countries, and that lymph node biopsy serves a vital role in diagnosing LNTB.
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Affiliation(s)
- Rui-Lin Ding
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Hong-Ying Cao
- Department of Emergency, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Yue Hu
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Chang-Ling Shang
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Fang Xie
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Zhen-Hua Zhang
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Qing-Lian Wen
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
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Lim RSM, Ramdave S, Beech P, Billah B, Karim MN, Smith JA, Safdar A, Sigston E. Utility of SUV max on 18 F-FDG PET in detecting cervical nodal metastases. Cancer Imaging 2016; 16:39. [PMID: 27821180 PMCID: PMC5100181 DOI: 10.1186/s40644-016-0095-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background The presence of cervical lymph node metastasis is an important prognostic factor for patients with head and neck squamous cell carcinomas (HNSCC). Accurate assessment of lymph node metastasis in these patients is essential for appropriate prognostic and management purposes. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) in assessing lymph node metastasis in HNSCC prior to surgery. Methods A retrospective review of 74 patients with HNSCC who underwent PET/CT prior to neck dissection were examined. Pre-operative PET/CT scans were reviewed by two experienced nuclear medicine physicians and SUVmax of the largest node in each nodal basin documented. These were compared with the histology results of the neck dissection. Results A total of 359 nodal basins including 86 basins with metastatic nodes were evaluated. A nodal SUVmax ≥3.16 yielded a sensitivity of 74.4 % and specificity of 84.9 % in detecting metastatic nodes. The nodal SUVmax/Liver SUVmax ratio was found on receiver operating characteristic (ROC) to be effective in detecting metastatic nodes with an area under ROC curve of 0.90. A nodal SUVmax/Liver SUVmax ratio ≥0.90 yielded a sensitivity of 74.1 % and specificity of 93.4 %. By comparison, visual inspection yielded sensitivities of 66.3 and 61.6 % in observers 1 and 2 respectively. The corresponding specificities were 77.7 and 86.5 %. Conclusions Nodal SUVmax and nodal SUVmax/liver SUVmax are both useful in the pre-operative detection of metastatic nodes with the latter being superior to visual inspection. The ratio is likely to be more useful as it corrects for inter-scanner variability.
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Affiliation(s)
- Rebecca S M Lim
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia. .,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia. .,Department of Radiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
| | - Shakher Ramdave
- Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia
| | - Paul Beech
- Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Nuclear Medicine, The Alfred, First Floor, East Block, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Baki Billah
- School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Md Nazmul Karim
- School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Adnan Safdar
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Elizabeth Sigston
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
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Sun P, Zhang F, Chen C, Bi X, Yang H, An X, Wang F, Jiang W. The ratio of hemoglobin to red cell distribution width as a novel prognostic parameter in esophageal squamous cell carcinoma: a retrospective study from southern China. Oncotarget 2016; 7:42650-42660. [PMID: 27223088 PMCID: PMC5173164 DOI: 10.18632/oncotarget.9516] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/16/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We propose a novel prognostic parameter for esophageal squamous cell carcinoma (ESCC)-hemoglobin/red cell distribution width (HB/RDW) ratio. Its clinical prognostic value and relationship with other clinicopathological characteristics were investigated in ESCC patients. RESULTS The optimal cut-off value was 0.989 for the HB/RDW ratio. The HB/RDW ratio (P= 0.035), tumor depth (P = 0.020) and lymph node status (P<0.001) were identified to be an independent prognostic factors of OS by multivariate analysis, which was validated by bootstrap resampling. Patients with a low HB/RDW ratio had a 1.416 times greater risk of dying during follow-up compared with those with a high HB/RDW (95% CI = 1.024-1.958, P = 0.035). MATERIALS AND METHODS We retrospectively analyzed 362 patients who underwent curative treatment at a single institution between January 2007 and December 2008. The chi-square test was used to evaluate relationships between the HB/RDW ratio and other clinicopathological variables; the Kaplan-Meier method was used to analyze the 5-year overall survival (OS); and the Cox proportional hazards models were used for univariate and multivariate analyses of variables related to OS. CONCLUSION A significant association was found between the HB/RDW ratio and clinical characteristics and survival outcomes in ESCC patients. Based on these findings, we believe that the HB/RDW ratio is a novel and promising prognostic parameter for ESCC patients.
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Affiliation(s)
- Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Fei Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Cui Chen
- Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province 510080, P. R. China
| | - Xiwen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Hang Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Xin An
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Fenghua Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
| | - Wenqi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province 510060, P. R. China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province 510060, P. R. China
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Kim JJ, Park JK, Moon SW. Usefulness of positron emission tomography-computed tomography in pre-operative evaluation of intra-thoracic esophageal cancer. Thorac Cancer 2015; 6:687-94. [PMID: 26557905 PMCID: PMC4632919 DOI: 10.1111/1759-7714.12237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/27/2014] [Indexed: 12/14/2022] Open
Abstract
Background The purpose of the study was to clarify the usefulness of positron emission tomography-computed tomography (PET-CT) for pre-operative evaluation of intra-thoracic esophageal cancer, especially in terms of regional lymph node status. Methods Medical records of 93 consecutive cases from July 2007 to October 2012 were retrospectively reviewed. All patients underwent curative and complete esophagectomies for intra-thoracic esophageal cancer. We compared pre-operative maximum standard uptake values (SUVmax) of esophageal tumors and regional lymph nodes (LN) with other variables (chronic obstructive pulmonary disease, history of previous other primary cancer, gender, differentiation, and neoadjuvant therapy). In addition, the SUVmax of tumors and LNs were analyzed with pathologic findings. Results There was no significant difference of each tumor and LN SUVmax according to factors including chronic lung disease, age, history of previous other cancer, differentiation, and gender. Pre-operative evaluations by PET-CT were not accurate (tumor sensitivity 76.4%, specificity 25%; LN sensitivity 45.2%, specificity 54.8%). Receiver operating characteristic analysis showed that LN metastasis could not be appropriately diagnosed with SUVmax (P = 0.871). There was no difference in SUVmax between pathologically positive and negative LN subgroups. Tumor SUVmax correlated with the progression of esophageal cancer in patients without neoadjuvant therapy (P < 0.001). However, LN SUVmax had no correlation with overall pathologic stage. After neoadjuvant therapy, there were significant decreases in SUVmax in both pathologically positive and negative LN subgroups (P = 0.043, P = 0.008). Conclusion Surgery should not be withheld in N-stage according to PET-CT findings and carefully considered in conjunction with other conditions.
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Affiliation(s)
- Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine Uijeongbu, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine Seoul, Korea
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Dai T, Popa E, Shah MA. The Role of 18F-FDG PET Imaging in Upper Gastrointestinal Malignancies. Curr Treat Options Oncol 2014; 15:351-64. [DOI: 10.1007/s11864-014-0301-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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