Hulya Wieshmann - PET / CT

PET CT inOesophagealCancerH Wieshmann, R Hanlon, D White,K Nash, N AlamDepartment of RadiologyUniversity Hospital Aintree

Objectives• Background information about the PET CT services• Update on PET CT services in Liverpool• Impact of PET CT in the staging of oesophagealcancer -12 months experience at UHA• Strengths and Limitations• Future developments

UK PET-CTAdvisory Board & Department of HealthFinal Version February 2009PET-CT Likely demand

Indications for NW Q2 Jul-Sep 080%5%0% 3% 2%3%Head and Neck(Parotid/Oropharynx/Larynx/Thyroid/Parathyroid)LungOesophagus10%Upper GI (Stomach/Small Bowel/Liver/Pancreas)Breast1%1%ColorectalGynaecological (Ovary/Uterus/Cervix)13%Lymphoma62%SarcomaUnknown PrimaryOther

6%1%5% 0%5%Indications for NW Q3 Oct-Dec 08Head and Neck(Parotid/Oropharynx/Larynx/Thyroid/Parathyroid)1%1%LungOesophagus11%Upper GI (Stomach/Small Bowel/Liver/Pancreas)ColorectalUrological (Renal/Adrenal/Bladder/Prostate/Testicle)1%Gynaecological (Ovary/Uterus/Cervix)Lymphoma14%55%SarcomaUnknown PrimaryOther

Referrals from NW Trusts15%Aintree UH0%28%CCOCountess of Chester7%CTCMid-Cheshire6%North CheshireRLBUHT7%8%Southport & OrmskirkSt Helens & Knowsley7%0%14%8%Walton CentreWUTH

Numbers120100806040200Referrers to NW PETReferrersLedson, M J Liverpool Heart and Chest HospitalM agennis, RF North CheshireM aguire, J Clatterbridge Centre for OncologyWalker, P Aintree UHSturgess, RP Aintree UHPoston, GJ Aintree UHSmyth, CM Liverpool Heart and Chest HospitalHendry, J St Helens and KnowsleyBenton, I Countess of ChesterCorless, J Wirral University Teaching HospitalFinnerty, JP Countess of ChesterWarburton, CJ Aintree UHLawrence, DS Wirral University Teaching HospitalStevenson, N Wirral University Teaching HospitalSmart, HL RLBUHTYouzguin, A Southport and OrmskirkLancaster, J Aintree UHShackcloth, M St Helens and KnowsleyM cM anus, CJ Southport and OrmskirkWahbi, ZK Wirral University Teaching HospitalScott, S Countess of ChesterJackson, SR Aintree UHTwite, S St Helens and KnowsleyBarben, CP Aintree UHEvans, J Countess of ChesterM alik, HZ Aintree UHAngus, RM Aintree UHRoland, NJ Aintree UHSmyth, CM RLBUHTStockton, PA St Helens and KnowsleyPage, RD Liverpool Heart and Chest HospitalM aguire, J Liverpool Heart and Chest Hospital

North West Upper GI Clinical Coding 2008-200910%2%3%StagingRestagingRecurrenceFollow-Up85%

North West Referring Hospitals 2008-0913%Aintree UH13%31%Cardiothoracic Centre, LiverpoolClatterbridge Centre for OncologyCountess Of Chester17%17%33%Liverpool Heart and Chest HospitalNobles Hospital IOMNorth CheshireRLBUHTSouthport and OrmskirkSt Helens and Knowsley1%2%20%1%Warrington HospitalWhiston Hospital2%7%20%3%1%2%

FDG PETCT for Oesophageal Cancer•All patients suitable for resection•All patients pre and post neo adjuvant therapy

April 2008-March 2009 Upper GIMDT at Aintree– 313 New diagnosis upper GI Ca– 148 newly diagnosed oesophageal cancer» Oesophageal resection 30

PET CT Audit Data Analysis• N = 51• Mean age =65.4 years• Female/Male=11/40 (22/78%)

Tumour site• Proximal intrathoracic oesophagus - 1(2%)• Middle intrathoracic oesophagus - 7(13.7%)• Distal intrathoracic oesophagus - 24(47%)• Junctional tumour - 19 (37.3%)

TNM staging on EUS29 Patients investigated with EUS– T1 - 2 (7%)– T2 - 11 (38%)– T3 - 15 (52%)– T4 - 1 (3%)– N0 - 17 (59%)– N1 - 12 (41%)– 2 examinations found M1 positive disease – 2 (7%)

TNM Classification on CT– T 1 / 2 disease - 2 (3.3%)– T 2 / 3 disease - 41 (80%)– T4 disease - 7 (13.7%)– N 0 disease - 16 (31.3%)– N 1 disease - 34 (66.6%)– M 0 disease - 39 (76.5%)– M 1a disease - 6 (12%)– M1b disease - 5 (10%)

N M staging on PETCT– N0 - 27 (53%)– N1 - 24 (47%)– M0 - 37 (72.5%)– M1a - 4 (8%)– M1b - 10 (19.5%)

PET CT compared with CT staging– Up in 12 (24%)–Down in 13 (25%)»No change 26 (51%)

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Conclusion• PET CT has a complementary role inpatients with Oesophageal cancer.• In our cohort FDG PET CT identified 9patients with M1B disease and preventedunnecessary surgery

Incidental Findings on PETCT• Oropharyngeal activity• Focal Thyroid activity• Focal Oesophageal activity• Focal colonic activity

Future• Static PET CT in Liverpool• Contrast-Enhanced 18F-FDG PET/CT:1-Stop-Shop Imaging for Assessing theResectability

:9:70Static PET CT in LiverpoolContrast-Enhanced 18F-FDGPET/CT: 1-Stop-Shop Imagingfor Assessing the Resectability

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