title: Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer.
abstract: BACKGROUND
  Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic ultrasound (EUS) in the staging of esophageal carcinoma were compared.
  
  
  METHODS
  PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer. Either tissue confirmation or fine needle aspiration (FNA) was used as the gold standard of disease. Sensitivity and specificity for tumor, nodal, and metastatic (TNM) disease for each test were determined. TNM categorizations from each test were used to assign patients to subgroups corresponding to the three treatment plans that patients could theoretically receive, and these were then compared.
  
  
  RESULTS
  Local tumor staging (T) was done correctly by CT and PET in 42% and by EUS in 71% of patients (P value > 0.14). The sensitivity and specificity for nodal involvement (N) by modality were 84% and 67% for CT, 86% and 67% for EUS, and 82% and 60% for PET (P value > 0.38). The sensitivity and specificity for distant metastasis were 81% and 82% for CT, 73% and 86% for EUS, and 81% and 91% for PET (P value > 0.25). Treatment assignment was done correctly by CT in 65%, by EUS in 75%, and by PET in 70% of patients (P value > 0.34).
  
  
  CONCLUSIONS
  EUS had superior T staging ability over PET and CT in our study group. The tests showed similar performance in nodal staging and there was a trend toward improved distant disease staging with CT or PET over EUS. Assignment to treatment groups in relation to TNM staging tended to be better by EUS. Each test contributed unique patient staging information on an individual basis.
authors.affiliation: Department of Radiology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA. vlowe@mayo.edu
authors.forename: Val J
authors.initials: VJ
authors.lastname: Lowe
authors.forename: Fargol
authors.initials: F
authors.lastname: Booya
authors.forename: J G
authors.initials: JG
authors.lastname: Fletcher
authors.forename: Mark
authors.initials: M
authors.lastname: Nathan
authors.forename: Eric
authors.initials: E
authors.lastname: Jensen
authors.forename: Brian
authors.initials: B
authors.lastname: Mullan
authors.forename: Eric
authors.initials: E
authors.lastname: Rohren
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Enrique
authors.initials: E
authors.lastname: Vazquez-Sequeiros
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Clain
mesh_terms: D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed