Limitations of 18F-FDG PET/CT in Detecting Direct Bronchial Metastasis from Esophageal Squamous Cell Carcinoma: A case report.

Articles in Press

Document Type : Case report

Authors

1 1, Tran Hung Dao ward, Hai Ba Trung district, Ha Noi

2 Hanoi Medical University, Ha Noi, Viet Nam

3 Histo-pathology department, Hopsital 108

4 Radiation Oncology and Radiosurgery, 108 Military Central Hospital, Hanoi, Vietnam

5 Cancer Institute, 108 Military Central Hospital, Hanoi, Vietnam

6 Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

7 Nuclear Medicine Department, Seoul National University Hospital

8 108 Military Central Hospital

10.22038/aojnmb.2025.90754.1662

Abstract

Esophageal cancers predominantly metastasize through direct invasion, lymphatic dissemination, or hematogenous spread. Frequent metastatic locations comprise the liver, lymph nodes, lungs, and bones. However, direct bronchial metastases are extremely rare and present significant diagnostic challenges. We report the case of a 50-year-old male diagnosed with esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiotherapy followed by esophagectomy with gastric pull-up reconstruction. Two years after surgery, routine follow-up imaging revealed a suspicious endobronchial lesion. On 18F-FDG PET/CT, the lesion demonstrated only mild uptake, potentially leading to underestimation of its malignant potential. Subsequent bronchoscopy and histopathological examination confirmed metastatic squamous cell carcinoma, consistent with the patient’s primary esophageal tumor. This unusual presentation highlights the limitations of relying solely on metabolic imaging in rare metastatic patterns. It further underscores the importance of a multimodal diagnostic strategy, integrating clinical evaluation, radiological findings, endoscopy, and tissue biopsy to achieve accurate diagnosis and guide optimal management in complex cases.

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Asia Oceania Journal of Nuclear Medicine and Biology

Articles in Press, Accepted Manuscript
Available Online from 08 November 2025

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