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Metastasis to Regional Lymph Nodes in Patients with Esophageal Squamous Cell Carcinoma: CT versus FDG PET for Presurgical Detection— Prospective Study¹

¹ From the Departments of Radiology (Y.C.Y., K.S.L., T.S.K.), Thoracic Surgery (Y.M.S., K.K.), and Nuclear Medicine (B.T.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. Received April 15, 2002; revision requested June 19; final revision received October 17; accepted November 5. Address correspondence to K.S.L. (e-mail: kslee@smc.samsung.co.kr).

View larger version (135K): [in a new window]   Figure 1a. Esophageal cancer in a 58-year-old man. (a) Mediastinal window of transverse contrast material-enhanced (7.0-mm collimation) CT scan obtained at the level of the suprahepatic inferior vena cava shows no demonstrable esophageal wall thickening or mass. (b) Transaxial FDG PET scan obtained at the same level as a shows an area of abnormally increased uptake (arrow) in the esophagus that proved to represent primary stage T2 squamous cell carcinoma.

View larger version (136K): [in a new window]   Figure 1b. Esophageal cancer in a 58-year-old man. (a) Mediastinal window of transverse contrast material-enhanced (7.0-mm collimation) CT scan obtained at the level of the suprahepatic inferior vena cava shows no demonstrable esophageal wall thickening or mass. (b) Transaxial FDG PET scan obtained at the same level as a shows an area of abnormally increased uptake (arrow) in the esophagus that proved to represent primary stage T2 squamous cell carcinoma.

View larger version (84K): [in a new window]   Figure 2a. Esophageal cancer in a 60-year-old man. (a) Mediastinal window of transverse contrast-enhanced (7.0-mm collimation) CT scan obtained at the level of azygos arch shows no markedly enlarged mediastinal lymph node. (b) Transaxial FDG PET scan obtained at same level as a shows an area of abnormally increased uptake (arrow) at the right paratracheal area that proved to represent a lymph node with metastasis at pathologic examination.

View larger version (116K): [in a new window]   Figure 2b. Esophageal cancer in a 60-year-old man. (a) Mediastinal window of transverse contrast-enhanced (7.0-mm collimation) CT scan obtained at the level of azygos arch shows no markedly enlarged mediastinal lymph node. (b) Transaxial FDG PET scan obtained at same level as a shows an area of abnormally increased uptake (arrow) at the right paratracheal area that proved to represent a lymph node with metastasis at pathologic examination.

View larger version (89K): [in a new window]   Figure 3a. Esophageal cancer in a 61-year-old man. Mediastinal windows of transverse contrast-enhanced (7.0-mm collimation) CT scans obtained at the level of (a) the distal trachea and (b) the bronchus intermedius show no evidence of markedly enlarged mediastinal or hilar lymph nodes. The wall (arrow in b) of the subcarinal midesophagus is slightly thickened; this was regarded as the location of the primary tumor. (c, d) Transaxial FDG PET images obtained at the same levels as a and b, respectively, show areas of abnormally increased uptake at the right hilum (standardized uptake value, 5.5) (arrow in d), left hilum (standardized uptake value, 3.8) (arrow in c), and subcarinal esophagus (arrowhead in d). Bilateral hilar lymph node groups were dissected and proved to be negative for malignancy at pathologic examination (results not shown). Stage T2 squamous cell carcinoma was found in the midesophagus in the surgical specimen (not shown).

View larger version (88K): [in a new window]   Figure 3b. Esophageal cancer in a 61-year-old man. Mediastinal windows of transverse contrast-enhanced (7.0-mm collimation) CT scans obtained at the level of (a) the distal trachea and (b) the bronchus intermedius show no evidence of markedly enlarged mediastinal or hilar lymph nodes. The wall (arrow in b) of the subcarinal midesophagus is slightly thickened; this was regarded as the location of the primary tumor. (c, d) Transaxial FDG PET images obtained at the same levels as a and b, respectively, show areas of abnormally increased uptake at the right hilum (standardized uptake value, 5.5) (arrow in d), left hilum (standardized uptake value, 3.8) (arrow in c), and subcarinal esophagus (arrowhead in d). Bilateral hilar lymph node groups were dissected and proved to be negative for malignancy at pathologic examination (results not shown). Stage T2 squamous cell carcinoma was found in the midesophagus in the surgical specimen (not shown).

View larger version (105K): [in a new window]   Figure 3c. Esophageal cancer in a 61-year-old man. Mediastinal windows of transverse contrast-enhanced (7.0-mm collimation) CT scans obtained at the level of (a) the distal trachea and (b) the bronchus intermedius show no evidence of markedly enlarged mediastinal or hilar lymph nodes. The wall (arrow in b) of the subcarinal midesophagus is slightly thickened; this was regarded as the location of the primary tumor. (c, d) Transaxial FDG PET images obtained at the same levels as a and b, respectively, show areas of abnormally increased uptake at the right hilum (standardized uptake value, 5.5) (arrow in d), left hilum (standardized uptake value, 3.8) (arrow in c), and subcarinal esophagus (arrowhead in d). Bilateral hilar lymph node groups were dissected and proved to be negative for malignancy at pathologic examination (results not shown). Stage T2 squamous cell carcinoma was found in the midesophagus in the surgical specimen (not shown).

View larger version (103K): [in a new window]   Figure 3d. Esophageal cancer in a 61-year-old man. Mediastinal windows of transverse contrast-enhanced (7.0-mm collimation) CT scans obtained at the level of (a) the distal trachea and (b) the bronchus intermedius show no evidence of markedly enlarged mediastinal or hilar lymph nodes. The wall (arrow in b) of the subcarinal midesophagus is slightly thickened; this was regarded as the location of the primary tumor. (c, d) Transaxial FDG PET images obtained at the same levels as a and b, respectively, show areas of abnormally increased uptake at the right hilum (standardized uptake value, 5.5) (arrow in d), left hilum (standardized uptake value, 3.8) (arrow in c), and subcarinal esophagus (arrowhead in d). Bilateral hilar lymph node groups were dissected and proved to be negative for malignancy at pathologic examination (results not shown). Stage T2 squamous cell carcinoma was found in the midesophagus in the surgical specimen (not shown).