Detection of distant metastases in esophageal cancer with (18)F-FDG PET.
Standard staging of esophageal and gastroesophageal junction (GEJ) tumors substantially lacks accuracy. The aim of this study was to investigate whether the addition of PET with (18)F-FDG is a valuable gain in the initial staging.


METHODS
Between January 1996 and January 2002, (18)F-FDG PET was performed in 74 patients. Conventional staging included CT in all patients and well-performed endoscopic ultrasonography (EUS) in 52 patients. They were compared with (18)F-FDG PET with pathology and follow-up of suspicious lesions as the gold standard.


RESULTS
PET identified 70 primary tumors (sensitivity, 95%). Sensitivity to identify locoregional metastases was highest for EUS (69%) but was not different for CT and PET (44% and 55%, respectively). PET was able to identify distant nodal disease in 71% (17/24 patients) compared with 29% (7/24 patients) after combined CT/EUS alone (P = 0.021). Sensitivity to detect distant nodal and systemic (M1) disease increased with PET (78% vs. 37%; P = 0.012). PET upstaged 15 patients (15/74; 20%) correctly as M1 disease, missed by CT/EUS, and correctly downstaged 4 patients (5%) from M1 to M0 disease. However, false upstaging and downstaging was encountered in 5 (7%) and 3 (4%) patients, respectively.


CONCLUSIONS
PET improves the currently applied staging of esophageal and GEJ tumors, particularly by ameliorating the detection of M1 disease.
Heeren
Pierre A M
PA
Department of Surgical Oncology, University Hospital of Groningen, Groningen, The Netherlands.
Jager
Pieter L
PL
Bongaerts
Fons
F
van Dullemen
Hendrik
H
Sluiter
Wim
W
Plukker
John Th M
JT
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18