Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans.
BACKGROUND
Pilot studies suggest positron emission tomography (PET) scanning may be superior to conventional imaging in staging esophageal cancer, especially in the detection of radiographically occult distant metastases. This report summarizes our experience with PET in staging esophageal cancer.


METHODS
One hundred consecutive PET scans in 91 patients with esophageal cancer referred for surgery were prospectively collected (1995 to 1998) and compared with computerized tomography (CT) and bone scan. PET images were acquired after injection of 18F-fluorodeoxyglucose and evaluated for abnormal uptake. Minimally invasive surgical staging (MIS) and/or clinical correlation were used to confirm or refute imaging results.


RESULTS
MIS or clinical correlation confirmed 70 distant metastases in 39 cases. PET detected 51 metastases in 27 of 39 cases (69% sensitivity, 93.4% specificity, 84% accuracy) compared with CT, which detected 26 metastases in 18 of 39 cases (46.1% sensitivity, 73.8% specificity, 63% accuracy) (p < 0.01).


CONCLUSIONS
PET was more accurate than CT in detecting distant metastases, but was only 69% sensitive compared with minimally invasive staging.
Luketich
J D
JD
Section of Thoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. luketichjd@msx.upmc.edu
Friedman
D M
DM
Weigel
T L
TL
Meehan
M A
MA
Keenan
R J
RJ
Townsend
D W
DW
Meltzer
C C
CC
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18