Prospective evaluation of positron emission tomography in the preoperative staging of esophageal carcinoma.
OBJECTIVE
Positron emission tomography (PET) is a useful tool in the selection of patients with esophageal cancer who may not benefit from esophageal resection.


METHODS
Case series.


METHODS
Tertiary care hospital.


METHODS
Eighty-one patients with newly diagnosed esophageal cancer who underwent PET and computer tomography (CT) of the chest and abdomen (and of the neck in 45 patients) within 45 days were included.


METHODS
We calculated the sensitivity and specificity in detecting metastatic sites on the basis of 31 histologically verified lesions. In addition to results obtained on CT, the information provided by PET was evaluated with a view to the choice of management strategies.


RESULTS
The PET findings had a higher specificity (89% vs 11%) but a lower sensitivity (38% vs 63%) than CT findings in the detection of metastatic sites. The CT results showed greater agreement with histopathological findings than did PET results. In 8 patients (10%), PET detected distant metastases that were not identified with CT. In 4 patients (5%), PET detected bone metastases only, but in all of these patients metastases in other locations were detected by CT. Although PET led to upstaging (M1) in 2 patients (2%), it did not enable the exclusion of esophageal resection.


CONCLUSIONS
Preoperative PET was not characterized by greater accuracy in the detection of metastatic sites previously identified by CT. Therefore, PET did not lead to a change in the indication for esophagectomy. An increase in the sensitivity and the combined use of CT and PET may lead to new indications for this staging procedure.
Kneist
Werner
W
Department of General and Visceral Surgery, Hospital of the Johannes Gutenberg-University, 55131 Mainz, Germany. kneist@ach.klinik.uni-mainz.de
Schreckenberger
Mathias
M
Bartenstein
Peter
P
Menzel
Christian
C
Oberholzer
Katja
K
Junginger
Theodor
T
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed