Application Value Of ¹⁸F-FDG PET/CT Texture Analysis In Evaluating The Staging Of Esophageal Cancer And In Assessing Neoadjuvant Chemotherapy Treatment

THE PURPOSE AND SIGNIFICANCEThe aim of this study was to investigate the value of 18F-FDG PET/CT texture analysis in evaluating of preoperative TNM staging with esophageal squamous cell carcinomas.We investigated the use of 18F-FDG PET/CT in detecting distant metastases of esophageal squamous cell carcinomas and concurrent double or multiple malignant tunors.To determine if the 18F-FDG PET/CT texture analysis are associated with therapeutic response in patients with neoadjuvant chemotherapy,and investigate the prognosis value of texture analysis.MATERIALS AND METHODSA retrospective medical record review was conducted in patients performed 18F-FDG PET/CT in Guangdong General Hospital.The clinical materials and the results of PET/CT were analyzed.Original DICOM data were processed for PET/CT texture analysis.1.From July 2007 to September 2015,137 patients with preoperative PET/CT were analyzed.To measure the PET texture analysis parameters of primary lesion.With pathology as the gold standard.The relationship between clinical data,texture analysis and T,N stage were analysised.The threshold value was obtained from the ROC curve.We analyzed the texture parameters between with and without lymph node metastasis group;compared between early and locally advanced esophageal cancer group.To analysis the relationship between clinicopathologic variables including PET texture parameters and occult lymph node metastasis and locally advanced esophageal cancer.2.From July 2007 to December 2016,the materials of 63 cases of primary esophageal cancer with distant metastasis and 38 cases with concurrent other malignant tumors were analyzed.Compare the PET texture parameters between with and without distant metastasis group of esophageal cancer patients.Analyze the distribution of distant metastasis and concurrent double or multiple malignant tumors.3.From July 2007 to December 2016,the materials of 38 cases of preoperative and 14 patients with sequence PET/CT examinations before and after neoadjuvant chemotherapy were analysed.With pathology as the gold standard.Compare the preoperative PET texture parameters in neoadjuvant chemotherapy patients between response group and unresponse group.Select the texture parameters with prognostic value.We analyzed the relationship between the valuable texture parameters with patient survival time.Results1.A positive correlation was observed between the length,SUVmax,SUVmean,MTV,TLG,Entropy,Homogeneity,LRE,Busyness of primary esophageal squamous carcinoma lesions and pathological T staging.A negative correlation was observed between Contrast,Dissimilarity,SRE,Coarseness,Complexity,SZE,SNE and pathological T staging.There are no correlation between esophageal squamous cell carcinoma patients' age,primary lesion length,degree of differentiation,lesion location,SUVmax,TLQ SUVmean,MTV,Contrast,Entropy,Homogeneity,Dissimilarity,SRE,LRE,Coarseness,Busyness,Complexity,SZE,LZE,SNE,LNE and esophageal N staging.There was no significant difference between regional lymph node metastasis and no regional lymph node metastasis groups in patients with clinically NO esophageal squamous cell carcinoma.The length,TLQ SUVmean,Entropy,Homogeneity,Coarseness and Busyness of primary lesions were significant difference between the early esophageal cancer and locally advanced esophageal cancer groups.2.The SUVmax,TLG,SUVmean,MTV,SULpeak,Contrast,Entropy,Homogeneity,Dissimilarity,SRE,LRE,Coarseness,Busyness,Complexity,SZE,LZE,SNE and LNE were significant difference between esophageal cancer with distant metastasis and without distant metastases groups.Esophageal cancer distant metastasis included liver,lung,bone,brain,adrenal glands,kidney,soft tissue nodules,neck,abdomen and pelvic lymph node.Esophageal cancer with concurrent malignant tumors included lung cancer,gastric cancer,colon cancer,rectal cancer,oropharyngeal cancer,liver cancer,thyroid cancer,laryngeal cancer,prostate cancer,bile duct carcinoma,maxillary sinus carcinoma and testicular germ cell tumors.3.The SUVmax,SULpeak before neoadjuvant chemotherapy and ?SUVmax,? SUVmean,? TLG,? MTV,? entropy(before and after neoadjuvant chemotherapy)were statistically significant different between response and no response groups in esophageal squamous cell carcinoma.The optimal threshold value of SUVmax and SULpeak to predict the response to neoadjuvant chemotherapy for esophageal cancer was 12.97 and-100994.80.There was statistically significant difference in progression free survival with the optimal threshold as the boundary value.Conclusion18F-FDG PET/CT was of great value in the evaluation of distant metastasis and concurrent malignant tumors in the first diagnosis of esophageal carcinoma patients.18F-FDG PET/CT texture analysis parameters had certain value in evaluating the esophageal squamous cell carcinoma T,M staging and evaluating the response of neoadjuvant chemotherapy and had prognosis valuation.But there was of little value in the N staging.18F-FDG PET/CT texture analysis parameters may provide more tumor assessment and prognostic information.Large sample and multicenter data for further research were nended.