Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma.

Background and Aims Positron emission tomography with computed tomography ( PET/ CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma ( EAC). However, the utility of PET/ CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/ CT findings with histopathological tumor invasion depth and survival outcomes. Methods EAC patients who underwent PET/ CT followed by endoscopic mucosal resection ( EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/ CT using the following parameters: detection of malignancy, fluorodeoxyglucose ( FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value ( SUVmax), and SUVmax ratio (lesion/liver). Results There were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥ T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio = 2.77, 95% confidence interval 1.26-7.73, P = 0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥ T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. Conclusions SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/ CT parameters and appears promising as a useful adjunct to the current diagnostic work-up. [ABSTRACT FROM AUTHOR]