Utility of [18F]FDG- PET/CT in Initial Staging and Management of Patients with Esophageal Carcinoma: A Tertiary Care Center Experience

Aim of the Study: This study aims to study the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) findings in the initial staging and management of patients with esophageal carcinoma. Materials and Methods: In this prospective study, we evaluated 74 patients with a mean age of 59.4 ± 11.6 with a range of 35–86 years. Comparison between the mean and standard deviation of SUV max of primary tumor between two histopathological groups, squamous cell carcinoma (SCC) and adenocarcinoma (AC) was done using unpaired Student’s t -test. The mean of SUV max of primary tumor in relation to localized tumor to nodal to distant metastases was assessed by ANOVA test. P <0.05 was considered statistically significant. The extent of agreement between findings of contrast-enhanced computed tomography (CECT) chest and abdomen and 18 F-FDG PET/CT was done using Cohen’s kappa coefficient (κ). Results: Among total n = 74 (42 males and 32 females with mean age 59.4 ± 11.4; range 35–86 years) patients, SCC was seen in 78.4% and AC in 21.6% of patients. There is a progressively increased SUV max value of primary tumor with nodal and distant metastases. 18 F-FDG PET/CT showed disease of Stage I-II in 12.1%, Stage III in 20.2%, Stage IVA in 25.6%, and Stage IVB in 41.8% patients. There is agreement between 18 F-FDG PET/CT and CECT chest and abdomen in the evaluation of regional lymph nodes (37.8% vs. 36.4%; κ – 0.96), nonregional lymph nodes (24.3% vs. 20.2%; κ −0.74), and distant organ involvement (21.6% vs. 17.5%; κ −0.82). In addition, 18 F-FDG PET/CT found synchronous malignancies in 4.0% of patients. Conclusion: 18 F-FDG PET/CT metabolic parameters help in identifying metastatic involvement in morphologically equivocal and clinically suspicious lesions in carcinoma esophagus patients. Being a whole-body imaging modality, 18 F-FDG PET/CT has inbuilt advantage to detect occult, distant metastases, and synchronous malignancies for effective staging and improving plan of clinical management.