Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma.
Because patients with carcinoma of the oesophagus usually present with advanced disease and surgery has a high mortality with cure in less than 10% of patients, pre-operative staging to select appropriate patients is necessary. Computed tomography (CT) plays an important role in staging but has well recognized limitations. Positron emission tomography (PET) which provides physiological information may therefore be a better alternative.


OBJECTIVE
To compare the findings of CT and positron emission tomography (PET) with 2-[18fluorine]-fluoro-2-deoxy-D-glucose (FDG) in the pre-operative staging of oesophageal carcinoma.


METHODS
Twenty-five patients with biopsy proven oesophageal cancer had pre-operative staging using CT and FDG-PET. The studies were read independently and full histological confirmation was obtained in 19 patients. Four parameters were studied: the primary tumour, peri-oesophageal lymph nodes, liver metastases and left gastric lymph nodes.


RESULTS
PET visualized all primary tumours; CT missed one. CT identified 4/8 patients with involved peri-oesophageal nodes and PET 3/8. CT identified 5/9 patients with left gastric adenopathy and PET 1/9. PET visualized a liver metastasis missed on CT and appeared to be better in assessing residual tumour. PET did identify distant metastases not seen on CT in seven patients.


CONCLUSIONS
The two techniques are both effective in showing the primary tumour and about equally sensitive in the demonstration of peri-oesophageal nodes. PET is probably more sensitive than CT for the detection of distant metastases.
Department of Diagnostic Radiology, Guy's and St. Thomas Hospital, London, UK.
S C
SC
Rankin
H
H
Taylor
G J
GJ
Cook
R
R
Mason
D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D018579:Patient Selection; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013270:Stomach; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18