title: Clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the staging of patients with potentially resectable esophageal cancer.
abstract: BACKGROUND
  (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) may play an important role in staging patients with potentially resectable esophageal cancer but its impact on clinical management remains unclear.
  
  
  METHODS
  In a multicenter prospective cohort study of patients with potentially resectable esophageal cancer, we compared stage of disease based on PET/CT with the stage based on conventional staging performed before PET/CT (American Joint Committee on Cancer, 6th edition). The primary outcome was the proportion of patients with a clinically important change in stage, based on PET/CT findings. We used health administrative databases to track health services use and mortality after the index PET/CT scan.
  
  
  RESULTS
  Four hundred ninety-one patients who received a PET/CT scan for staging of potentially resectable esophageal cancer were included in the study cohort. PET/CT led to clinically important changes in stage for a total of 188 patients (24.0%): 107 patients (21.8%) were upstaged and 11 patients (2.2%) were downstaged. Results of PET/CT were associated with differences in actual management. At the 6-month follow-up, use of surgery was greater in patients with M0 disease (54.4%) compared with those with M1a (25.0%; p < 0.001) or M1b (7.3%; p < 0.001) disease based on PET/CT. The overall cohort had a median survival of 603 days, and higher stage of disease on PET/CT (i.e., M stage) was associated with shorter survival (p < 0.001).
  
  
  CONCLUSIONS
  PET/CT identifies disease not otherwise detected on conventional staging and results in clinically important changes in stage for an appreciable number of patients with potentially resectable esophageal cancer and can make important contributions to the management of these patients.
authors.affiliation: *Departments of Medicine, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; †Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Departments of ‡Radiation Oncology and §Surgery, University of Toronto, Ontario, Canada; ‖Department of Radiology, McMaster University, and Integrated Department of Nuclear Medicine and Molecular Imaging, Hamilton, Ontario, Canada; ¶Department of Nuclear Medicine, Lebanon VA Medical Center, Lebanon, Pennsylvania; and #Department of Oncology, McMaster University, and Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
authors.forename: Rebecca K S
authors.initials: RK
authors.lastname: Wong
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
authors.forename: Karen
authors.initials: K
authors.lastname: Gulenchyn
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Urbain
authors.forename: William K
authors.initials: WK
authors.lastname: Evans
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18