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

doi:10.3748/wjg.v23.i15.2743

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World Journal of Gastroenterology

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World J Gastroenterol. Apr 21, 2017; 23(15): 2743-2749
Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2743

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

Masau Sekiguchi, Takashi Terauchi, Yasuo Kakugawa, Naoki Shimada, Yutaka Saito, Takahisa Matsuda

Masau Sekiguchi, Yasuo Kakugawa, Takahisa Matsuda, Cancer Screening Center, National Cancer Center Hospital, Tokyo 104-0045, Japan

Masau Sekiguchi, Yasuo Kakugawa, Yutaka Saito, Takahisa Matsuda, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan

Masau Sekiguchi, Takahisa Matsuda, Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan

Takashi Terauchi, Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan

Takashi Terauchi, Department of Nuclear Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 104-0045, Japan

Naoki Shimada, Department of Radiological Technology Radiological Diagnosis, National Cancer Center Hospital, Tokyo 104-0045, Japan

Author contributions: Sekiguchi M designed the study, analyzed and interpreted the data, and drafted the article; Terauchi T, Kakugawa Y, Shimada N, Saito Y, and Matsuda T collected, analyzed and interpreted the data, and contributed to the critical revision of the article for important intellectual content; all authors had final approval of the article.

Supported by (in part) the National Cancer Center Research and Development Fund, No. 27-A-5.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee for Clinical Research of the National Cancer Center.

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: None of the authors report a conflict of interest.

Data sharing statement: No additional data are available.

Correspondence to: Masau Sekiguchi, MD, Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. masekigu@ncc.go.jp

Telephone: +81-3-35422511 Fax: +81-3-35423815

Received: January 6, 2017
Peer-review started: January 9, 2017
First decision: February 9, 2017
Revised: February 23, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: April 21, 2017
Processing time: 103 Days and 22.7 Hours

Abstract

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 FDG-PET 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 FDG-PET 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.

Keywords: Cancer screening; Esophageal cancer; Esophagogastroduodenoscopy; Positron emission tomography; Screen sensitivity

Core tip: The present study first clarified the performance of 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) for esophageal cancer screening by adopting an appropriate study method. A large number of asymptomatic screened individuals who underwent both FDG-PET and esophagogastroduodenoscopy were included in the study, and the performance of FDG-PET was assessed by comparing the results of FDG-PET and esophagogastroduodenoscopy, considering the latter as the reference. As a result, the low screen sensitivity (3.6%) and positive predictive value (2.0%) of FDG-PET for esophageal cancer were clearly shown. Based on the results, FDG-PET is considered to be difficult to use as a screening modality for esophageal cancer.