COMPUTED-TOMOGRAPHY AND POSITRON-EMISSION-TOMOGRAPHY IN THE PREOPERATIVE STAGING OF ESOPHAGEAL-CARCINOMA

Because patients with carcinoma of the oesophagus usually present with advanced disease and surgery has a high mortality with cure in less t han 10% of patients, pre-operative staging to select appropriate patie nts is necessary. Computed tomography (CT) plays an important role in staging but has well recognized limitations. Positron emission tomogra phy (PET) which provides physiological information may therefore be a better alternative. Objective : To compare the findings of CT and posi tron emission tomography (PET) with 2-[(18)fluorine]-fluoro-2-deoxy-D- glucose (FDG) in the pre-operative staging of oesophageal carcinoma. M aterials and Methods: Twenty-five patients with biopsy proven oesophag eal cancer had pre-operative staging using CT and FDG-PET. The studies were read independently and full histological confirmation was obtain ed in 19 patients. Four parameters were studied: the primary tumour, p eri-oesophageal lymph nodes, liver metastases and left gastric lymph n odes. Results: PET visualized all primary tumours; CT missed one. CT i dentified 4/8 patients with involved peri-oesophageal nodes and PET 3/ 8. CT identified 5/9 patients with left gastric adenopathy and PET 1/9 . PET visualized a liver metastasis missed on CT and appeared to be be tter in assessing residual tumour. PET did identify distant metastases not seen on CT in seven patients. Conclusions: The two techniques are both effective in showing the primary tumour and about equally sensit ive in the demonstration of peri-oesophageal nodes. PET is probably mo re sensitive than CT for the detection of distant metastases.