Sc. Rankin et al., COMPUTED-TOMOGRAPHY AND POSITRON-EMISSION-TOMOGRAPHY IN THE PREOPERATIVE STAGING OF ESOPHAGEAL-CARCINOMA, Clinical Radiology, 53(9), 1998, pp. 659-665
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.