A prospective trial for the evaluation of esophageal cancer patients: FDG PET/CT vs. c.e.CT vs. FDG PET/c.e.CT

Objectives The present study was conceived on a population of esophageal cancer patients (ECP) who have been undergoing FDG PET/CT and c.e.CT in a single session, both at initial staging and after more than 4 weeks from the end of neoadjuvant treatment. Herein, we reported the preliminary data about the comparison of diagnostic performance among PET/CT, c.e.CT and PET/c.e.CT. Methods To date, 89 ECP (62±12years) were recruited, with adenocarcinoma or squamous cell carcinoma who underwent basal PET/CT plus c.e.CT in a single session. The glycemic recorded value was not higher than 170mg/dL and insulin-dependent diabetic patients were excluded from recruitment, according to RECIST guideline. After 60min from the injection of FDG, a whole body PET/CT scan was acquired. At the end of standard acquisition, a neck-thorax-abdomen c.e.CT was performed; in particular three c.e. phases for the liver evaluation were made. Three specialized physicians read the images, separately. Results 89 patients performed both PET/CT and c.e.CT while 86 of them had all three scans. The agreement among the three scans was ranged between 40% and 53% of subjects. In discordant patients, c.e.CT demonstrated more lymph node metastases than both PET/CT and PET/c.e.CT (in 22.5% and 16.9% of subjects, respectively). Conversely, PET/c.e.CT showed less loco-regional/distant lymph nodes and distant metastases than PET/CT and c.e.CT alone, thus reducing the rate of false-positive and false-negative findings (rate of distant metastases: 39% for c.e.CT, 24.7% for PET/CT and 22.5% for PET/c.e.CT). The clinical staging was recovered in 40 patients. The sensitivity of PET/c.e.CT was higher than PET/CT alone and similar to c.e.CT for the identification of metastases (63% vs. 48% and 64%, respectively). Conclusions In ECP, at initial staging FDG PET/c.e.CT represents an accurate and feasible method for recognizing a major number of pathological findings in comparison with PET/CT and c.e.CT, separately performed.