Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma

Table 1 Clinicopathological characteristics of patients

Variable	Total (n = 82)
Clinical variables
Sex
Male	63
Female	19
Age (yr), mean ± SD	64.7 ± 9.06
Tumor location
Upper thoracic	6
Middle thoracic	46
Lower thoracic	30
Circumferential extension
< 3/4	71
≥ 3/4	11
Macroscopic type
0-I	5
0-IIa	2
0-IIc	75
Primary treatment
EMR-C	7
ESD	57
Surgery	18
Depth of tumor invasion by, EP-LPM	49
NBI with magnification
MM-SM1	26
SM2-SM3	7
Lymph node metastasis
Positive	3
Negative	79
Pathological variables
Depth of tumor invasion
pTis	4
pT1a	61
pT1b	17
Diameter of primary tumor (mm), mean ± SD	30.5 ± 18.5
Lymph node metastasis
Positive	8
Negative	10
Infiltrative growth pattern
INFa	50
INFb	32
Histological grade
Well	30
Moderate	47
Poor	5
Vascular invasion
Positive	15
Negative	67
Lymphatic invasion
Positive	19
Negative	63

SD: Standard deviation; EMR-C: Endoscopic mucosal resection using a cap-fitted endoscope; ESD: Endoscopic submucosal dissection; EP: Mucosal epithelium; LPM: Lamina propria mucosae; MM: Muscularis mucosae; SM1: Upper third of the submucosal layer; SM2: Middle third of the submucosal layer; SM3: Lower third of the submucosal layer; INF: Infiltrative growth pattern.

Table 2 Association between fluorodeoxyglucose positron emission tomography/computed tomography detection of primary tumors and clinicopathological variables

Variable	Positive (n = 29)	Negative (n = 53)	P value
Clinical variables
Sex			0.88
Male	22	41
Female	7	12
Age (yr), mean ± SD	64.4 ± 11.3	64.8 ± 7.66	0.86
Tumor location
Upper thoracic	2	4
Middle thoracic	16	30	0.98
Lower thoracic	11	19
Circumferential extension
< 3/4	21	50	0.014
≥ 3/4	8	3
Macroscopic type
0-I	3	2
0-IIa	25	50	0.46
0-IIc	1	1
Pathological variables
Depth of tumor invasion
Tis + T1a	14	51	< 0.001
T1b	15	2
Length diameter of primary tumor (mm), mean ± SD	36.4 ± 21.87	27.2 ± 15.70	0.052
Infiltrative growth pattern
INFa	9	41	< 0.001
INFb	20	12
Histological grade
Well	4	26	0.002
Moderate+poor	25	27
Vascular invasion
Positive	11	4	0.001
Negative	18	49
Lymphatic invasion
Positive	14	5	< 0.001
Negative	15	48

SD: Standard deviation; INF: Infiltrative growth pattern.

Table 3 Multivariate analysis of the associations between positive fluorodeoxyglucose positron emission tomography/computed tomography and pathological variables

Variable	OR	95%CI	P value
Circumferential extension
< 3/4	3.26	0.52-20.49	0.21
≥ 3/4
Histological grade
Well	3.09	0.71-13.48	0.13
Moderate + poor
Depth of tumor invasion
pTis + pT1a	30.21	1.81-504.05	0.018
pT1b
Infiltrative growth pattern
INFa	1.52	0.38-6.18	0.56
INFb
Vascular invasion
Positive	3.42	0.24-49.86	0.37
Negative
Lymphatic invasion
Positive	0.26	0.012-5.41	0.38
Negative

INF: Infiltrative growth pattern; OR: Odds ratio; CI: Confidence interval.

Table 4 Diagnostic performance of invasion depth using narrow band imaging magnification before treatment for superficial esophageal carcinoma

	Type B1 for EP-LPM	Type B2 for MM-SM1	Type B3 for SM2-3
Sensitivity	87.5% (42/48)	68.4% (13/19)	46.7% (7/15)
Specificity	79.4% (27/34)	79.4% (50/63)	100% (67/67)
PPV	85.7% (42/49)	50.0% (13/26)	100% (7/7)
NPV	81.8% (27/33)	89.3% (50/56)	89.3% (67/75)
Accuracy	84.1% (69/82)	76.8% (63/82)	90.2% (74/82)

EP: Mucosal epithelium; LPM: Lamina propria mucosae; MM: Muscularis mucosae; SM1: Upper third of the submucosal layer; SM2: Middle third of the submucosal layer; SM3: Lower third of the submucosal layer; PPV: Positive predictive value; NPV: Negative predictive value.

Table 5 Diagnostic performance for invasion depth of SM2-3 or lesions indicated for surgery or chemoradiotherapy by fluorodeoxyglucose positron emission tomography alone

	Invasion depth of SM2-3	Lesions indicated for surgery or CRT	P value
Sensitivity	93.3% (14/15)	78.3% (18/23)	0.37
Specificity	77.6% (52/67)	81.4% (48/59)	0.60
PPV	48.2% (14/29)	62.1% (18/29)	0.29
NPV	98.1% (52/53)	90.6% (48/53)	0.12
Accuracy	80.5% (66/82)	80.5% (66/82)	1.00

SM2: Middle third of the submucosal layer; SM3: Lower third of the submucosal layer; CRT: Chemoradiotherapy; PPV: Positive predictive value; NPV: Negative predictive value.

Table 6 Diagnostic performance for lesions indicated for surgery or chemoradiotherapy by Fluorodeoxyglucose positron emission tomography alone and Fluorodeoxyglucose positron emission tomography combined with magnifying endoscopy-narrow band imaging

	FDG-PET	FDG-PET + ME-NBI	P value
Sensitivity	78.3% (18/23)	78.3% (18/23)	1.00
Specificity	81.4% (48/59)	91.5% (54/59)	0.12
PPV	62.1% (18/29)	78.3% (18/23)	0.24
NPV	90.6% (48/53)	91.5% (54/59)	0.86
Accuracy	80.5% (66/82)	87.8% (72/82)	0.20

CRT: Chemoradiotherapy; ME-NBI: Magnifying endoscopy-narrow band imaging; FDG-PET: Fluorodeoxyglucose positron emission tomography; PPV: Positive predictive value; NPV: Negative predictive value.