Usefulness of 18F-fluorodeoxyglucose positron emission tomography for T1 esophageal squamous cell carcinoma

The utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for T1 esophageal cancer is unclear. This study analyzed the usefulness of FDG-PET for T1 esophageal squamous cell carcinoma (ESCC). Medical records of patients with T1 ESCC between December 2008 and July 2024 at Pusan National University Yangsan Hospital were retrospectively reviewed. The preoperative FDG-PET/CT findings and final pathological results of patients with T1 ESCC confirmed by surgery or endoscopic resection were compared. Among the 133 patients with T1 ESCC, 84 (63.2%) had mucosal cancer, 49 (36.8%) had submucosal cancer, and 9 (6.8%) had lymph node metastasis. The maximal standardized uptake value (SUVmax) of the PET/CT images was positively correlated with the invasion depth (r = 0.670; P < .001) and tumor length (r = 0.518; P < .001). PET confirmed FDG uptake in 8 cases of mucosal cancer and 35 cases of submucosal cancer (9.5% vs 71.4%; P < .001). The negative predictive value and positive predictive value of FDG-PET/CT for identifying mucosal cancer were 84% and 81%, respectively. Of the 8 mucosal cancers in which FDG uptake was observed during PET, 5 (62.5%) were whole or near-circumferential lesions. FDG uptake observed using PET/CT was positively correlated with the invasion depth and tumor length of T1 ESCC. FDG-PET/CT may provide complementary information for risk stratification in patients with T1 ESCC.