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.