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Comparative Study
. 2020 Jul;17(3):239-249.
doi: 10.1007/s10388-019-00704-w. Epub 2019 Dec 9.

Diagnostic performance of diffusion-weighted magnetic resonance imaging in assessing lymph node metastasis of esophageal cancer compared with PET

Kiyohiko Shuto  1   2 , Tsuguaki Kono  3 , Toru Shiratori  3 , Yasunori Akutsu  3 , Masaya Uesato  3 , Mikito Mori  3   4 , Kazuo Narushima  3   4 , Shunsuke Imanishi  4 , Yoshihiro Nabeya  3 , Noriyuki Yanagawa  5 , Shinichi Okazumi  3   6 , Keiji Koda  3   4 , Hisahiro Matsubara  3
Affiliations
Comparative Study

Diagnostic performance of diffusion-weighted magnetic resonance imaging in assessing lymph node metastasis of esophageal cancer compared with PET

Kiyohiko Shuto et al. Esophagus. 2020 Jul.

Abstract

Background: Although diffusion-weighted magnetic resonance imaging (DWI) for detecting lymph node (LN) metastasis is reported to be a successful modality for primary malignant tumors, there are few studies relating to esophageal cancer. This study aimed to clarify the diagnostic performance of DWI for assessing LN metastasis compared with positron emission tomography (PET) in patients with esophageal squamous cell cancer (eSCC).

Methods: Seventy-six patients with histologically proven eSCC who underwent curative esophagectomy without neoadjuvant treatment were reviewed retrospectively. Harvested LNs were divided into 1229 node stations with 94 metastases. Diagnostic abilities and prognostic significance were compared.

Results: In a station-by-station evaluation, the sensitivity was higher in DWI than PET (67% vs. 32%, P < 0.001). DWI showed more than 80% sensitivity for middle- and large-sized cancer nests and large area of cancer nests. The DWI-N0 group had a better 5-year relapse-free survival rate than the DWI-N+ group (78.5% vs. 34.2%, P < 0.001), as did the PET-N0 group. DWI-N status was an independent prognostic factor (hazard ratio [HR], 2.642; P = 0.048), as was PET-N status (HR 2.481; P = 0.033).

Conclusions: DWI, which depends on cancer cell volume followed by elevated intranodal density, is a non-invasive modality and showed higher sensitivity than PET. It has clinical impact in predicting postoperative survival for patients with eSCC alongside its diagnostic ability and has significant performance in clinical practice.

Keywords: Diffusion-weighted MRI; Esophageal cancer; Lymph node; PET.

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Conflict of interest statement

The authors have no conflicts of interest and received no financial support for this study.

Figures

Fig. 1
Fig. 1
True positive lymph node of 10 mm in size by DWI and PET (arrow). a Thoracic paratracheal lymph node was detected on contrast-enhanced CT as metastasis. It was hyperintense on DWI (b) and hyperaccumulate on PET (c). d The node was identified as metastatic with 100% of intranodal cancer nest
Fig. 2
Fig. 2
False negative lymph node of 10 mm in size by DWI and PET (arrow). a Paracardial lymph node was detected on contrast-enhanced CT as metastasis. It was hypointense on DWI (b) and hypoaccumulate on PET (c). d, e The node was identified as metastatic with micrometastasis (d square, e arrow)
Fig. 3
Fig. 3
Comparison of the size of true positive nodes and false negative nodes between DWI and PET. a True positive node. b False negative node
Fig. 4
Fig. 4
Overall survival curves according to DWI-N status and PET-N status. a DWI-N status. b PET-N status. DWI-N0, clinical negative for lymph node metastasis by DWI; DWI-N+, clinical positive for metastasis by DWI; PET-N0, clinical negative for lymph node metastasis by PET; PET-N+, clinical positive for lymph node metastasis by PET
Fig. 5
Fig. 5
Relapse-free survival curves according to DWI-N status and PET-N status. a DWI-N status. b PET-N status. DWI-N0 clinical negative for lymph node metastasis by DWI, DWI-N+ clinical positive for metastasis by DWI, PET-N0 clinical negative for lymph node metastasis by PET, PET-N+ clinical positive for lymph node metastasis by PET
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