• European radiology · May 2018

    Cervical ultrasonography has no additional value over negative 18F-FDG PET/CT scans for diagnosing cervical lymph node metastases in patients with oesophageal cancer.

    • Lucas Goense, Jihane Meziani, van Rossum Peter S N PSN Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands., Frank J Wessels, Lam Marnix G E H MGEH Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., Richard van Hillegersberg, and Jelle P Ruurda.
    • Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
    • Eur Radiol. 2018 May 1; 28 (5): 2031-2037.

    ObjectivesTo investigate the additional value of cervical ultrasonography over 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.MethodsBetween January 2013 and January 2016, 163 patients with newly diagnosed oesophageal cancer underwent both cervical ultrasonography and 18F-FDG PET/CT at a tertiary referral centre in the Netherlands. Retrospective clinical data analysis was performed to assess the diagnostic value of cervical ultrasonography and 18F-FDG PET/CT for the detection of cervical lymph node metastases. Fine needle aspiration or clinical follow-up was used as reference standard.ResultsThe overall incidence of patients with cervical lymph node metastases was 14%. The sensitivity of 18F-FDG PET/CT to detect cervical lymph node metastases was 82% (95% CI 59-94%) and specificity was 91% (95% CI 85-95%). The sensitivity and specificity of cervical ultrasonography were 73% (95% CI 50-88%) and 84% (95% CI 77-90%), respectively. In patients with a negative 18F-FDG PET/CT, 12 of 133 (9%) patients had suspicious nodes on cervical ultrasonography. In all these 12 patients the nodes were confirmed benign.ConclusionsCervical ultrasonography has no additional diagnostic value to a negative integrated 18F-FDG PET/CT for the detection of cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.Key Points• Cervical ultrasonography has no value over PET/CT in evaluating cervical node metastases. • PET/CT provides greater diagnostic confidence compared to cervical ultrasonography. • Cervical ultrasonography during standard diagnostic work-up may be considered unnecessary. • Cervical lesions on PET/CT require cytopathological confirmation by FNA.

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