Performance of 18-fluoro-2-deoxyglucose positron emission tomography for esophageal cancer screening

摘要

AIM To evaluate the performance of 18-fluoro-2-deoxyglucose positron emission tomography(FDG-PET) for esophageal cancer(EC) screening.METHODS We retrospectively analyzed the data of consecutive asymptomatic individuals who underwent FDG-PET and esophagogastroduodenoscopy(EGD) simultaneously for cancer screening at our institution from February 2004 to March 2013. In total, 14790 FDG-PET and EGD procedures performed for 8468 individuals were included in this study, and the performance of FDGPET for EC screening was assessed by comparing the results of FDG-PET and EGD, considering the latter as the reference.RESULTS Thirty-two EC lesions were detected in 28 individuals(31 squamous cell carcinomas and 1 adenocarcinoma). The median tumor size was 12.5 mm, and the depths of the lesions were as follows: Tis(n = 12), T1a(n = 15), and T1b(n = 5). Among the 14790 FDG-PET procedures, 51 examinations(0.3%) showed positive findings in the esophagus; only 1 was a true-positive finding. The screen sensitivity, specificity, positive predictive value, and negative predictive value of FDGPET for ECs were 3.6%(95%CI: 0.1-18.3), 99.7%(95%CI: 99.6-99.7), 2.0%(95%CI: 0.0-10.4), and 99.8%(95%CI: 99.7-99.9), respectively. Of the 50 FDG-PET false-positive cases, 31 were observed in the lower esophagus, and gastroesophageal reflux disease was observed in 17 of these 31 cases.CONCLUSION This study is the first to clarify the FDG-PET performance for EC screening. Based on the low screen sensitivity, FDG-PET is considered to be difficult to use as a screening modality for ECs.