title: Does FDG-PET add information to EUS and CT in the initial management of esophageal cancer? A prospective single center study.
abstract: OBJECTIVE
  There is no algorithm for the initial staging of esophageal cancer that is considered standard of care. This prospective blinded study analyzes the utility of FDG-PET as an adjunct to EUS and CT for the management of patients with esophageal cancer.
  
  
  METHODS
  Between December 2003 and October 2006, patients diagnosed with esophageal carcinoma underwent EUS, CT, and FDG-PET at their initial evaluation. Two thoracic surgeons were given staging EUS results and CT scan reports. They were asked if the patient needed surgical resection, neoadjuvant chemotherapy followed by resection, or palliation. With each case, one surgeon was unblinded to the FDG-PET results. The treatment decisions of each surgeon were compared to determine if PET altered clinical management.
  
  
  RESULTS
  A total of 50 patients (45 male, 5 female) were enrolled and data were prospectively collected. Forty-three (86%) had adenocarcinoma and 7 (14%) had squamous cell carcinoma. EUS was completed in 88% (44) of cases while 6 (12%) were incomplete secondary to tight stenosis. Nineteen were treated with surgery, 25 with neoadjuvant chemotherapy and surgery, and 6 with palliative chemoradiation. In 49 of 50 patients, the surgeons came to identical management decisions independent of PET results. In the one case that the treatment decision differed, the EUS was incomplete. The agreement on treatment strategy was 98% (kappa= 0.97, 95% CI 0.93-0.99).
  
  
  CONCLUSIONS
  This study shows that the addition of FDG-PET to EUS and CT offers little information to the initial treatment stratification of patients with esophageal cancer. However, in patients with incomplete EUS, FDG-PET may have some clinical utility.
authors.affiliation: Department of Gastroenterology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: McDonough
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.forename: K R
authors.initials: KR
authors.lastname: Shen
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Roman L
authors.initials: RL
authors.lastname: Galysh
authors.forename: Alfredo
authors.initials: A
authors.lastname: Hernandez
authors.forename: Grace E
authors.initials: GE
authors.lastname: White
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D004945:Esophagoscopy; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18