Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma

Gang Sun, Jianmin Tian, Emmanuel C. Gorospe, Geoffrey B. Johnson, Christopher H. Hunt, Lori S. Lutzke, Cadman Leggett, Prasad G Iyer, Kenneth Ke Ning Wang

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Aims: Positron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes. Methods: EAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver). Results: There were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio=2.77, 95% confidence interval 1.26-7.73, P=0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. Conclusions: SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work-up.

Original languageEnglish (US)
Pages (from-to)975-981
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume28
Issue number6
DOIs
StatePublished - 2013

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Adenocarcinoma
Survival
Neoplasms
Esophagectomy
Liver
Positron Emission Tomography Computed Tomography
Comorbidity
Multivariate Analysis
Retrospective Studies
Odds Ratio
Databases
Confidence Intervals
Pathology
Neoplasm Metastasis
Sensitivity and Specificity
Mortality
Endoscopic Mucosal Resection

Keywords

  • Endoscopic resection
  • Esophageal adenocarcinoma
  • Positron emission tomography

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology
  • Medicine(all)

Cite this

Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma. / Sun, Gang; Tian, Jianmin; Gorospe, Emmanuel C.; Johnson, Geoffrey B.; Hunt, Christopher H.; Lutzke, Lori S.; Leggett, Cadman; Iyer, Prasad G; Wang, Kenneth Ke Ning.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 28, No. 6, 2013, p. 975-981.

Research output: Contribution to journalArticle

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title = "Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma",
abstract = "Background and Aims: Positron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes. Methods: EAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver). Results: There were 72 eligible patients: 42 (58.3{\%}) had T1a lesions, and 30 (41.7{\%}) had ≥T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio=2.77, 95{\%} confidence interval 1.26-7.73, P=0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3{\%} and 80.9{\%}, respectively. Adjusting the SUVmax ratio to 2.14, 16.7{\%} (5/30) of ≥T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. Conclusions: SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work-up.",
keywords = "Endoscopic resection, Esophageal adenocarcinoma, Positron emission tomography",
author = "Gang Sun and Jianmin Tian and Gorospe, {Emmanuel C.} and Johnson, {Geoffrey B.} and Hunt, {Christopher H.} and Lutzke, {Lori S.} and Cadman Leggett and Iyer, {Prasad G} and Wang, {Kenneth Ke Ning}",
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T1 - Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma

AU - Sun, Gang

AU - Tian, Jianmin

AU - Gorospe, Emmanuel C.

AU - Johnson, Geoffrey B.

AU - Hunt, Christopher H.

AU - Lutzke, Lori S.

AU - Leggett, Cadman

AU - Iyer, Prasad G

AU - Wang, Kenneth Ke Ning

PY - 2013

Y1 - 2013

N2 - Background and Aims: Positron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes. Methods: EAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver). Results: There were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio=2.77, 95% confidence interval 1.26-7.73, P=0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. Conclusions: SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work-up.

AB - Background and Aims: Positron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes. Methods: EAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver). Results: There were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio=2.77, 95% confidence interval 1.26-7.73, P=0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. Conclusions: SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work-up.

KW - Endoscopic resection

KW - Esophageal adenocarcinoma

KW - Positron emission tomography

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