Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans

Background. Pilot studies suggest positron emission tomography (PET) scanni ng may be superior to conventional imaging in staging esophageal cancer, es pecially in the detection of radiographically occult distant metastases. Th is report summarizes our experience with PET in staging esophageal cancer. Methods. One hundred consecutive PET scans in 91 patients with esophageal c ancer referred for surgery were prospectively collected (1995 to 1998) and compared with computerized tomography (CT) and bone scan. PET images were a cquired after injection of 18F-fluorodeoxyglucose and evaluated for abnorma l uptake. Minimally invasive surgical staging (MIS) and/or clinical correla tion were used to confirm or refute imaging results. Results. MIS or clinical correlation confirmed 70 distant metastases in 39 cases. PET detected 51 metastases in 27 of 39 cases (69% sensitivity, 93.4% specificity, 84% accuracy) compared with CT, which detected 26 metastases in 18 of 39 cases (46.1% sensitivity, 73.8% specificity, 63% accuracy) (p < 0.01). Conclusions. PET was more accurate than CT in detecting distant metastases, but was only 69% sensitive compared with minimally invasive staging. (C) 1 999 by The Society of Thoracic Surgeons.