The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer.
OBJECTIVE
To study the utility of whole-body positron emission tomography with (18)F-fluoro-deoxy-D -glucose (FDG-PET) for the evaluation of recurrence after curative resection of cancer of the esophagus or gastroesophageal junction.


METHODS
Forty-one patients with a clinical or radiologic suspicion of recurrent disease underwent conventional diagnostic work-up, including a spiral computed tomographic scan, an endoscopic ultrasound, and a dedicated whole-body FDG-PET. PET lesions were classified as equivocal or suspicious recurrence. The conventional diagnostic work-up and PET findings were correlated with pathology or with radiologic and clinical follow-up. Equivocal lesions were classified as positive.


RESULTS
Forty recurrences were found in 33 patients. The lesions were perianastomotic (n = 9), regional (n = 12), and at distant sites (n = 19). For the diagnosis of a perianastomotic recurrence, the sensitivity, specificity, and accuracy of FDG-PET were 100%, 57%, and 74%, versus 100%, 93%, and 96% for conventional diagnostic work-up, respectively (P = not significant). False-positive PET lesions were found in patients with a progressive anastomotic stenosis requiring repetitive endoscopic dilatation. For the diagnosis of regional and distant recurrences, the sensitivity, specificity, and accuracy of PET were 94%, 82%, and 87%, versus 81% (P = not significant), 82% (P = not significant), and 81% (P =.0771) for conventional diagnostic work-up. All false-positive PET lesions (n = 4) had been reported as equivocal. On a patient base, PET provided additional information in 11 of 41 (27%) patients. A major impact on diagnosis was found in 5 patients with equivocal or negative findings on complete diagnostic work-up in whom PET provided a true-positive diagnosis. In 5 other patients the diagnosis was staged upward from localized to extended recurrent disease, and in 1 patient with an equivocal complete diagnostic work-up, PET correctly excluded malignancy.


CONCLUSIONS
FDG-PET allows a highly sensitive diagnosis and accurate whole-body staging of symptomatic recurrent esophageal cancer. Further studies in asymptomatic patients are needed to assess the potential benefit on survival.
Flamen
P
P
Departments of Nuclear Medicine, Internal Medicine, Radiology, and Thoracic Surgery, University Hospital Gasthuisberg, Katholieke Universiteit Leuven (KUL), Leuven, Belgium. Patrick.Flamen@uz.kuleuven.ac.be
Lerut
A
A
Van Cutsem
E
E
Cambier
J P
JP
Maes
A
A
De Wever
W
W
Peeters
M
M
De Leyn
P
P
Van Raemdonck
D
D
Mortelmans
L
L
D000230:Adenocarcinoma / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D004946:Esophagostomy; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005743:Gastrectomy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging / Q000379:methods*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014055:Tomography, Emission-Computed / Q000379:methods; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18