title: FDG-PET nodal staging does not correlate with histopathological nodal stage for oesophageal cancers.
abstract: OBJECTIVE
  To investigate whether pre-operative N-stage (nodal stage) based on FDG-PET for oesophageal cancers, correlates with final histopathology. Additionally, we assessed if N-stage differs for squamous cell cancers compared with adenocarcinomas and if neoadjuvant therapy alters these results.
  
  
  BACKGROUND
  Our current understanding of oesophageal cancer biology means that personalisation of multimodality therapy is based on accurate clinical staging, allied with patient co morbidities and patient preference.
  
  
  METHODS
  We conducted a retrospective review of consecutive oesophagectomy cases performed over a ten year period (between 2002 and 2013) from a single tertiary centre. A total of 161 patients were identified in the study period.
  
  
  RESULTS
  Overall, 103 specimens with 1402 lymph nodes were included. For both Adenocarcinomas (AC) and Squamous Cell Carcinomas (SCC), there was no significant difference between the N-stage determined by CT vs. FDG-PET (p > 0.05). For AC, there was statistically significant under-reporting of the N-stage by PET compared with the final histopathology (p < 0.01). Subgroup analysis showed that neoadjuvant therapy vs. adjuvant therapy alone did not alter the bias for under-reporting of the N-stage for adenocarcinoma by PET-CT (Bland-Altman bias 0.76 vs. bias 0.75).
  
  
  CONCLUSIONS
  There is little doubt that PET-CT provides useful information in determining metastatic disease however its use in evaluating nodal burden is limited. Theoretically, this should not preclude patients from receiving definitive surgical management but the decision regarding neoadjuvant treatment based on locoregional disease may be affected.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia; Department of Trauma Surgery, Westmead Hospital, NSW, Australia. Electronic address: mdevadas@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Devadas
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Department of Nuclear Medicine and PET, Liverpool Hospital, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Cosman
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Ziazaris
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Wilson
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Upper Gastrointestinal Surgery, Liverpool Hospital, NSW, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Merrett
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D016629:Esophagectomy / Q000706:statistics & numerical data; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Adenocarcinoma; Cancer; Oesophageal; PET; Squamous; Staging