Irfan Akbar Kayani MBBS, Abstract Co-Author: Nothing to Disclose

Ashley McAllister Groves MBBS, Abstract Co-Author: Nothing to Disclose

Yong Du, Abstract Co-Author: Nothing to Disclose

Leon Menezes FRCR, Presenter: Nothing to Disclose

Sue Siew Chen Chua MBBS, Abstract Co-Author: Nothing to Disclose

Jamshed Bomanji MBBS, Abstract Co-Author: Nothing to Disclose

Laurence Lovat PhD, Abstract Co-Author: Nothing to Disclose

Peter Josef Ell MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Patients with esophageal dysplasia are at high risk for coexisting invasive carcinoma. We reviewed the value of FDG PET-CT by assessing FDG uptake and its prognostic significance in patients with esophageal dysplasia.

We examined our institutions database over a 3 year period and identified 10 patients (8 males and 2 females; mean age 75 years) with esophageal dysplasia without invasive carcinoma that underwent FDG PET-CT scans. The PET-CT scan reports were reviewed for FDG uptake at the site of dysplasia. The presence or absence of FDG uptake was correlated with the results of follow up biopsies at the dysplastic site.

There were 9 patients with severe intestinal type dysplasia associated with Barrett’s esophagus and 1 patient with squamous carcinoma-in-situ. PET-CT scans were performed within 1 month of endoscopic biopsy and histology. Increased FDG uptake was reported at the site of oesophageal dysplasia in 4 patients (peak SUV between 3.6-8.1). Of these 4 patients 3 were proven with follow up biopsy to have invasive carcinoma at site of known dysplasia (2 adenocarcioma, 1 squamous carcinoma) at 1, 6, and 6 months post PET-CT scan. One patient with a positive PET scan at dysplastic site died of bronchopneumonia 3 months later without further histology follow up. There were 6 patients without increased FDG uptake at dysplasia site (peak SUV between 1.3-2.4). 1 of these 6 patients was proven to have invasive adenocarcinoma 3 months following negative PET-CT scan. None of the other 5 patients with negative PET-CT scans developed carcinoma during follow up (14-36 month follow up duration). The sensitivity and specificity of PET-CT for detecting invasive carcinoma was 75% and 75%.

FDG uptake at sites of esophageal dysplasia was highly suggestive of invasive carcinoma. All invasive carcinomas at dysplastic site developed within 6 months of follow up and therefore may represent detection of pre-existing occult carcinomas.

These results indicate that PET-CT has the potential to improve clinical management by detecting occult carcinomas in patients with severe esophageal dysplasia and carcinoma-in-situ.

Kayani, I, Groves, A, Du, Y, Menezes, L, Chua, S, Bomanji, J, Lovat, L, Ell, P, et al, , The Value of FDG PET-CT in Patients with Esophageal Dysplasia.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4442189.html