Comparison of the diagnostic value of 3-deoxy-3-18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of regional lymph node in thoracic esophageal squamous cell carcinoma: a pilot study

Diseases of the Esophagus, 04/25/2012

F–fluorothymidine (FLT) uptake in regional lymph nodes of esophageal carcinoma is significantly lower compared with FDG uptake. 3–deoxy–3–18F–fluorothymidine positron emission tomography/computed tomography (FLT PET/CT) has fewer false–positive findings and higher specificity compared with FDG PET/CT.

Methods

  • Twenty-two patients with thoracic esophageal squamous cell carcinoma underwent dual-tracer PET/CT examinations before surgery.
  • The results of reviewing CT images and side-by-side FDG PET and FLT PET images for the diagnosis of locoregional lymph node metastasis were compared prospectively in relation to pathologic findings.
  • All patients underwent esophagectomy and lymphadenectomy.

Results

  • Pathologic examination confirmed nodes positive for metastasis in 16 patients and 47 of 424 excised nodes.
  • The uptake of FDG (median SUVmax, 5.4; range, 2.4-10.6) in locoregional lymph nodes metastases was significantly higher than that of FLT (median SUVmax, 2.8; range, 1.3-4.6).
  • There were 14 false-positive nodes in FDG PET/CT and only 3 in FLT PET/CT; 8 false-negative nodes in FDG PET/CT, while there were 12 false negative nodes in FLT PET/CT.
  • The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FLT PET/CT were 74.47%, 99.20%, 96.46%, 92.11%, and 96.89%, respectively, whereas those of FDG PET/CT were 82.98%, 96.29%, 94.81%, 82.98%, and 96.29%, respectively.
  • P-values were 0.450, 0.014, 0.313, 0.050, and 0.555, respectively.

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