Rivka Rachel Colen MD, Presenter: Nothing to Disclose

Kevin R King, Abstract Co-Author: Nothing to Disclose

Hima Prabhakar MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated, Bloomington, IN

Alan Fischman, Abstract Co-Author: Nothing to Disclose

Michael Austin Blake MBBCh, Abstract Co-Author: Nothing to Disclose

To develop a classification scheme that will improve identification of cancer-related nonspecific FDG uptake in the esophagus. We sought to 1) characterize the nature of uptake in established esophageal cancer or esophageal metastasis and 2) determine the clinical significance of cancer-related FDG uptake in the esophagus by correlating with endoscopy and histopathology.

We identified patients noted to have abnormal FDG uptake within the esophagus on whole body PETCT/PET scan. We then identified those patients having 1) known primary esophageal cancer or esophageal metastasis, and 2) endoscopic and pathological evidence of disease. A classification scheme was developed to characterize location (proximal, middle and distal), distribution (diffuse, segmental, and focal), eccentricity (eccentric or concentric) and homogeneity (homogenous or heterogeneous) of FDG uptake in the esophagus in each imaging study. Three radiologists (R1, R2, R3) reviewed the images retrospectively.

145 patients were found to have FDG uptake in the esophagus. Of these, 16% (23/145) had known esophageal cancer or metastasis with associated endoscopic and histopathologic characterization. 26% (6/23) of the established cancers or metastases were histopatholigically determined to be squamous carcinomas, while the remaining 74%(17/23) found to be adenocarcinomas. 65%(15/23) of cases were classified as having high uptake, while 35%(8/23) were classified as medium or low. Comparisons of FDG uptake classification to histopathology findings revealed that of 11 focal uptake cases, 84% (9/11) were adenocarcinoma. In contrast, squamous cell carcinomas were classified as segmental in 67% (4/6) of cases and focal in only 33% (2/6) of cases.

The results presented here, will help define the range of uptake patterns found in esophageal cancers and metastasis, and provide the basis for refinement of the classification scheme to ultimately improve identification of cancer-related causes of nonspecific esophageal FDG uptake.

This work will provide the basis for refining esophageal uptake classification scheme and improving identification of cancer-related causes of nonspecific esophageal FDG uptake.

Colen, R, King, K, Prabhakar, H, Mueller, P, Fischman, A, Blake, M, Classification of Esophageal 18F-FDG Uptake in Established Esophageal Cancer Using PET/CT: Correlation with Endoscopic and Histopathologic Analysis.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4427012.html