Positron emission tomography of esophageal carcinoma using11C-choline and18F-fluorodeoxyglucose

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Abstract
Accurate preoperative staging is an important but difficult problem in determining therapy for patients with esophageal carcinoma. Positron emission tomography (PET) is used with [methyl-11C]choline (11C-choline) and 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) to detect a variety of malignancies. The authors used PET with both of these agents to detect lymph node metastases in patients with esophageal carcinoma. Lymph node metastases in 33 patients with biopsy-proven esophageal carcinoma (16 patients with tumors classified as T1 and 17 patients with tumors classified as T2–4) was examined by PET using 11C-choline and 18F-FDG, and the accuracy of the results was correlated with pathology findings after surgery. 11C-choline PET was more effective than 18F-FDG PET and computed tomography (CT) in detecting very small metastases localized in the mediastinum. It was ineffective, however, in detecting metastases localized in the upper abdomen, because of the normal uptake of 11C-choline in the liver. 18F-FDG PET was superior to CT in detecting metastases in the mediastinum and the upper abdomen, whereas 11C-choline PET was superior to 18F-FDG PET in detecting metastases in the mediastinum. When 11C-choline PET and 18F-FDG PET were used in combination, they were very effective in evaluating the lymph node status in both the mediastinum and the upper abdomen, and detected 85% of the metastatic lymph nodes (n = 46). In this study, the combination of 11C-choline PET and 18F-FDG PET was very effective in evaluating the lymph node status of patients with esophageal carcinoma preoperatively. Cancer 1999;86:1638–48. © 1999 American Cancer Society.