POSITRON-EMISSION-TOMOGRAPHY FOR STAGING OF ESOPHAGEAL AND GASTROESOPHAGEAL MALIGNANCY

Positron emission tomography (PET) with [F-18]-fluoro-2-deoxy-D-glucos e (FDG) was prospectively investigated as a means of detecting metasta tic disease in patients with oesophageal tumours and compared with com puterized tomography (CT), with the surgical findings as a gold standa rd. Twenty-six patients with a malignant tumour of the oesophagus or g astroesophageal junction underwent CT and PET of the chest and the abd omen. Seven patients underwent laparoscopy to establish resectability. Fifteen patients underwent laparotomy without prior laparoscopy. Four patients did not undergo surgery. The primary tumour was visualized i n 81% of patients with CT and in 96% with PET. Neither CT nor PET were suited to assess the extent of wall invasion. Surgically assessed nod al status corresponded in 62% with CT and in 90% with PET. Distant met astases were found in five patients with CT and in eight with PET. The diagnostic accuracy of CT in determining resectability was 65% and fo r PET 88%. For CT and PET together this was 92%. The present study ind icates that FDG-PET can be of importance for staging patients with oes ophageal tumours. PET has a higher sensitivity for nodal and distant m etastases and a higher accuracy for determining respectability than CT . PET and CT together would have decreased ill-advised surgery by 90%.