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Updated: Jan 21, 2026

Development of Compendium for Esophageal Squamous Cell Carcinoma
Published on: April 12, 2024
Prediction of lymph node metastasis by PET/CT metabolic parameters in patients with esophageal squamous cell
Manman Xu1, Ling Wang2, Mingli Ouyang1
1Departments of Radiology and PET/CT.
Objective:
The aim of this study was to investigate the capability of F-FDG PET/computed tomography (CT)-related metabolic parameters to predict lymph node metastasis (LNM) and occult lymph node metastasis (OLNM) in patients with esophageal squamous cell carcinoma (ESCC).
Methods:
Totally 84 patients undergoing curative esophagectomy with lymph node dissection were enrolled in this study. Metabolic tumor volume (MTV) was measured using threshold-based methods with a threshold of 40% maximum standardized uptake value (SUVmax). The derivative of the volume (V)-threshold (T) function (volume difference/threshold difference) was defined as the heterogeneity factor (HF). In addition, SUVmax, SUVmean, total lesion glycolysis (TLG), maximum tumor-to-blood SUV ratio (SURmax), SURmean and several clinicopathologic parameters were analyzed to identify risk factors of LNM and OLNM.
Results:
SUVmax, SUVmean, MTV, TLG, SURmax, SURmean and HF were significantly different between LNM (+) and LNM (-). The optimal cut-off values of those parameters were 12.5, 8.34, 15.01, 117.185, 7.885, 4.855 and 0.300, respectively. Logistic regression analysis showed that MTV (OR = 1.127, P = 0.04) and SURmax (OR = 1.446, P = 0.004) were independent predictors of LNM, with sensitivity and specificity were 51.2%, 83.7% vs. 53.7%, 79.1%. In univariate and multivariate analysis, MTV was the sole parameter associated with OLMN (P = 0.024).
Conclusion:
MTV and SURmax were statistically significant predictors of LNM in patients with ESCC, while MTV was a predictor of OLNM. High SURmax and MTV may indicate that the treatment planning should be tailored, which may improve patient prognosis.
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