The Value Of ¹⁸F-FDG PET/CT Imaging In The Recurrence And Metastasis Of Post-treatment Esophageal Carcinoma

Objective:Analyzing the diagnostic of ¹⁸F-FDG PET/CT imaging in recurrent esophageal carcinoma compare with pathological results or clinical follow up data, including Sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Analysizing and comparing the diagnostic efficacy difference of PET/CT, PET and CT in local recurrence. Statistically analysizing and comparing the diagnostic efficacy of ¹⁸F-FDG PET/CT imaging in esophageal squamous cell carcinoma, adenocarcinoma and SUV max value of local recurrence. Statistically analysizing and comparing the diagnostic efficacy of ¹⁸F-FDG PET/CT imaging in distant metastasis lung metastasis, bone metastasis and liver metastasis. Statistically analysizing and comparing the diagnostic efficacy of PET/CT, PET and CT in lung metastasis. Statistically analysizing and comparing the SUVmax value of the local recurrence group, the lymph node metastasis group and the distant metastasis group. Investigate the value of ¹⁸F-FDG PET/CT imaging in the recurrence and metastasis of post-treatment esophageal carcinoma with the comparision and analysis above. Methods:We statistically analyse the clinical data, pathological findings and PET / CT data from 169 suspected recurrence or metastasis esophageal carcinoma patients, who treated in Tianjin Medical University Cancer Institute and Hospital from January 2010 to December 2015 by ¹⁸F-FDG PET/CT imaging, to evaluate the diagnostic value of ¹⁸F-FDG PET/CT in recurrent esophageal carcinoma. We screen the cases in strict accordance with the gold standard based on pathological results for the cases with surgery or biopsy, as for the cases without surgery or biopsy, we screen according with lastest six months clinical follow-up including imaging tests and related tumor treatment to diagnose the condition of recurrence or metastasis. We calculate the diagnostic of ¹⁸F-FDG PET/CT imaging in recurrent esophageal carcinoma, including Sensitivity, specificity, accuracy, positive predictive value and negative predictive value in accordance with the standard formula, and compare with pathological results or follow-up data for Kappa consistency test. We calculate and compare the diagnostic efficacy difference of ¹⁸F-FDG PET/CT, PET and CT in local recurrence and do χ2 test at the same tme. There are two main pathological type of esophageal carcinoma, they are squamous cell carcinoma and adenocarcinoma, squamous cell carcinoma is the most common one. We calculate and compare the diagnostic efficacy of ¹⁸F-FDG PET/CT in squamous cell carcinoma and adenocarcinoma, and divide the ture postive cases into two groups based on pathological types, then compare the SUVmax value of these two groups through independent T-test. We calculate the diagnostic efficacy of ¹⁸F-FDG PET/CT in distant metastasis lung metastasis, bone metastasis and liver metastasis and pairwise compare the differences and similarities through χ2 test. We calculate and compare the differences among diagnostic efficacy of ¹⁸F-FDG PET/CT, PET, CT using χ2 test, and calculate the SUVmax value of the local recurrence group, the lymph node metastasis group and the distant metastasis group to confirm whether there is difference among them through independent T-test. Results:（1） In 169 treated esophageal carcinoma cases, recurrence or metastasis was found in 137 cases of them by ¹⁸F-FDG PET/CT imaging, whose accuracy is 93.5%（158/169）, sensitivity is 99.2%（127/128）, specificity is 75.6%（31/41）, positive predictive value is 92.7%（127/137）,negative predictive value is 96.9%（31/32）. Kappa consistency test is good comparing with the diagnostic criteria.（2）The sensitivity of PET/CT and PET are better than CT（P=0.017）,the other diagnostic performances showed no significant difference in them. The ¹⁸F-FDG PET/CT imaging in squamous carcinoma diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.5%、100%、96.0%、93.3%、100%, in adenocarcinoma were 83.3%、100%、75.0%、66.7%、100%. In squamous carcinoma the diagnostic accuracy is higher（P=0.011）,the maximum mean SUVmax value is 10.1±3.5（9.9,3.7-20）higher than 6.2±2.8（5.2,4.1-10.4）in adenocarcinoma（P=0.038）.（3） In 169 treated esophageal carcinoma cases, distance metastasis was found in 52 cases of them including 23 cases lung metastasis and 15 cases liver metastasis, there isn’t diagnostic difference among the three methods. And 25 cases lung metastasis were found through ¹⁸F-FDG PET/CT, the diagnostic sensitivity of PET/CT and CT is better than PET（P=0.036）.（4） the SUVmax value of ¹⁸F-FDG PET/CT in the local recurrence, the lymph node metastasis and the distant metastasis were 9.9±3.6（9.8,3.7-20）, 11.8±4.6（10.8,3.1-21.2）, 10.4±3.5（10.1,3.0-21.4）, and it is higher in the lymph node metastasis cases than in the local recurrence cases. Conclusions:（1） ¹⁸F-FDG PET/CT has great value in the diagnosis of esophageal carcinoma recurrence and metastasis, provides evidence to determine whether patients relapse or metastasize in clinical judgment.（2） Kappa consistency test is good on the diagnostic of ¹⁸F-FDG PET/CT imaging in recurrent esophageal carcinoma comparing with pathological results or follow-up data.（3） the diagnostic sensitivity of ¹⁸F-FDG PET/CT is better than PET and CT in local recurrence and lung metastasis.（4） the diagnostic accuracy and the SUVmax value of ¹⁸F-FDG PET/CT in recurrent esophageal carcinoma are higher than the data in adenocarcinoma, so the diagnostic efficacy of PET/CT is better in recurrent esophageal carcinoma whose metabolism is more active.（5） the most common distant metastasis of esophageal carcinoma are lung metastasis, bone metastasis and liver metastasis,and there isn’t difference among the diagnostic efficacy of ¹⁸F-FDG PET/CT for these three sites. The following is serosal metastasis, and adrenal metastasis, muscle metastases and parotid metastases are not familiar.（6） The mean SUVmax value is different in different metastases, lymph node metastasis is higher than local recurrence.