Performance of 18-fluoro-2-deoxyglucose positron emission tomography for esophageal cancer screening

AIM To evaluate the performance of 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) for esophageal cancer (EC) screening. METHODS We retrospectively analyzed the data of consecutive asymptomatic individuals who underwent FDG-PET and esophagogastroduodenoscopy (EGD) simultaneously for cancer screening at our institution from February 2004 to March 2013. In total, 14790 FDG-PET and EGD procedures performed for 8468 individuals were included in this study, and the performance of FDG-PET for EC screening was assessed by comparing the results of FDG-PET and EGD, considering the latter as the reference. RESULTS Thirty-two EC lesions were detected in 28 individuals (31 squamous cell carcinomas and 1 adenocarcinoma). The median tumor size was 12.5 mm, and the depths of the lesions were as follows: Tis (n = 12), T1a (n = 15), and T1b (n = 5). Among the 14790 FDG-PET procedures, 51 examinations (0.3%) showed positive findings in the esophagus; only 1 was a true-positive finding. The screen sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for ECs were 3.6% (95%CI: 0.1-18.3), 99.7% (95%CI: 99.6-99.7), 2.0% (95%CI: 0.0-10.4), and 99.8% (95%CI: 99.7-99.9), respectively. Of the 50 FDG-PET false-positive cases, 31 were observed in the lower esophagus, and gastroesophageal reflux disease was observed in 17 of these 31 cases. CONCLUSION This study is the first to clarify the FDG-PET performance for EC screening. Based on the low screen sensitivity, FDG-PET is considered to be difficult to use as a screening modality for ECs.