Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma

Purpose: A prospective study of preoperative tumor-node-metastasis staging of patients with esophageal cancer (EC) was designed to compare the accurac y of 18-F-fluoro-deoxy-D-glucose (FDG) position emission tomography (PET) w ith conventional noninvasive modalities. Patients and Methods: Seventy-four patients with carcinomas of the esophagu s (n = 43) or gastroesophageal junction (n = 31) were studied. All patients underwent attenuation-corrected FDG-PET imaging, a spiral computed tomogra phy (CT) scan, and an endoscopic ultrasound (EUS). Results: FDG-PET demonstrated increased activity in the primary tumor in 70 of 74 patients (sensitivity: 95%). False-negative PET images were found in four patients with T1 lesions. Thirty-four patients (46%) had stage IV dis ease. FDG-PET had a higher accuracy for diagnosing stage IV disease compare d with the combination of CT and EUS (82% v 64%, respectively; P = .004). F DG-PET had additional diagnostic value in It. (22%) of 74 patients by upsta ging 11 (15%) and downstaging five (7%) patients. Thirty-nine (53%) of the 74 patients underwent a 2- or 3-field lymphadenectomy in conjunction with p rimary curative esophagectomy. In these patients, tumoral involvement was f ound in 21 local and 35 regional or distant lymph nodes (LN). For local LN, the sensitivity of FDG-PET was lower than EUS (33% v 81%, respectively; P = .027), but the specificity may have been higher (89% v 67%, respectively; P = not significant [NS]). For the assessment of regional and distant LN i nvolvement, compared with the combined use of CT and EUS, FDG-PET had a hig her specificity (90% v 98%, respectively; P = .025) and a similar sensitivi ty (46% v 43%, respectively; P = NS). Conclusion: PET significantly improver the detection of stage IV disease in EC compared with the conventional staging modalities. PET improves diagnos tic specificity for LN staging. (C) 2000 by American Society of Clinical On cology.