title: [Positron emission tomography for the preoperative staging of esophageal carcinoma].
abstract: OBJECTIVE
  Exact preoperative staging is a prerequisite for the indication as well as the choice of the appropriate operative technique for patients with esophageal carcinoma. In this prospective study we assessed whether positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) increases the accuracy of staging compared to standard computer tomography (CT) and leads to a different therapeutic approach.
  
  
  METHODS
  30 patients (25 men, 5 women, median age 63 years) with histologically identified carcinoma of the esophagus (n =29) and the cardia (n = 1), respectively, were studied. All patients underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity and accuracy were calculated for FDG-PET and CT to evaluate the detection of histologically identified lymph node metastases and distant metastatic disease.
  
  
  RESULTS
  FDG-PET showed higher specificity whereas the accuracy of the CT proved to be higher not only for the detection of abdominal lymph node metastases (67 % vs. 46 %), but also for lymph node metastases of the thorax (71 % vs. 50 %). Furthermore, the accuracy of the CT for the detection of blood-bone and lymphatic distant metastases was also higher than that of FDG-PET (72 % vs. 68 %). FDG-PET was more specific (100 % vs. 71 %) albeit less sensitive than CT-imaging (27 % vs. 73 %).
  
  
  CONCLUSIONS
  In our study, FDG-PET did not increase the accuracy of standard staging (CT) in patients with carcinoma of the esophagus. Therefore, no new consequences resulted for the operative indication as well as therapeutic procedure. Due to the high costs involved with PET investigation, this form of staging is momentarily indicated mainly for use in clinical studies, and in cases where CT does not offer unequivocal results. Increase in sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals as well as optimized apparatus resolution could lead to new indications for this staging procedure.
authors.affiliation: Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Klinikum der Johannes Gutenburg-Universität, Mainz. sekretariat@ach.klinik.uni-mainz.de
authors.forename: Th
authors.initials: T
authors.lastname: Junginger
authors.forename: W
authors.initials: W
authors.lastname: Kneist
authors.forename: M
authors.initials: M
authors.lastname: Schreckenberger
authors.forename: C
authors.initials: C
authors.lastname: Menzel
authors.forename: K
authors.initials: K
authors.lastname: Oberholzer
authors.forename: P
authors.initials: P
authors.lastname: Bartenstein
mesh_terms: D002277:Carcinoma / Q000000981:diagnostic imaging*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000191:economics / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18