title: Positron emission tomography-computed tomography in oesophageal cancer staging: a tailored approach.
abstract: BACKGROUND
  Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the staging of oesophageal cancer to identify occult metastases not apparent on CT and changes the management in typically 3-18% patients. The authors aim to re-evaluate its role in the management of oesophageal cancer, investigating whether it is possible to identify a group of patients that will not benefit and can safely be spared from this investigation.
  
  
  METHODS
  Consecutive patients with oesophageal cancer undergoing PET-CT staging between 2010 and 2013 were identified from a specialist modern multidisciplinary team database. Without knowledge of the PET-CT result, patients were stratified into low-risk or high-risk groups according to the likelihood of identifying metastatic disease on PET-CT based on specified criteria routinely available from endoscopy and CT reports. Clinical outcomes in the two groups were investigated.
  
  
  RESULTS
  In 383 undergoing PET-CT, metastatic disease was identified in 52 (13.6%) patients. Eighty-three patients were stratified as low risk and 300 as high risk. None of the low-risk patients went on to have metastatic disease identified on PET-CT. Of the high-risk patients, 17% had metastatic disease identified on PET-CT.
  
  
  CONCLUSIONS
  In one of the largest studies to date investigating the influence of staging PET-CT on management of patients with oesophageal cancer, the authors report a classification based on endoscopy/CT criteria is able to accurately stratify patients according to the risk of having metastatic disease. This could be used to avoid unnecessary PET-CT 22% of patients, saving cost, inconvenience and reducing potential delay to definitive treatment in this group.
authors.affiliation: Peninsula Oesophago-gastric Unit, Derriford Hospital, Plymouth, Devon, PL6 8DH, UK, davidbunting@nhs.net.
authors.forename: David M
authors.initials: DM
authors.lastname: Bunting
authors.forename: Wesley W
authors.initials: WW
authors.lastname: Lai
authors.forename: Richard G
authors.initials: RG
authors.lastname: Berrisford
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Wheatley
authors.forename: Brent
authors.initials: B
authors.lastname: Drake
authors.forename: Grant
authors.initials: G
authors.lastname: Sanders
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*