The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer

Objective: To study the utility of whole-body positron emission tomography with F-18-fluoro-deoxy-D-glucose (FDG-PET) for the evaluation of recurrence after curative resection of cancer of the esophagus or gastroesophageal ju nction. Methods: Forty-one patients with a clinical or radiologic suspicion of recu rrent disease underwent conventional diagnostic work-up, including a spiral computed tomographic scan, an endoscopic ultrasound, and a dedicated whole -body FDG-PET. PET lesions were classified as equivocal or suspicious recur rence. The conventional diagnostic work-up and PET findings were correlated with pathology or with radiologic and clinical follow-up. Equivocal lesion s were classified as positive. Results: Forty recurrences were found in 33 patients. The lesions were peri anastomotic (n = 9), regional (n = 12), and at distant sites (n = 19). For the diagnosis of a perianastomotic recurrence, the sensitivity, specificity , and accuracy of FDG-PET were 100%, 57%, and 74%, versus 100%, 93%, and 96 % for conventional diagnostic work-up, respectively (P = not significant). False-positive PET lesions were found in patients with a progressive anasto motic stenosis requiring repetitive endoscopic dilatation. For the diagnosi s of regional and distant recurrences, the sensitivity, specificity, and ac curacy of PET were 94%, 82%, and 87%, versus 81% (P = not significant), 82% (P = not significant), and 81% (P =.0771) for conventional diagnostic work -up. All false-positive PET lesions (n = 4) had been report ed as equivocal . On a patient base, PET provided additional information in 11 of 41 (27%) patients. A major impact on diagnosis was found in 5 patients with equivoca l or negative findings on complete diagnostic work up in whom PET provided a true-positive diagnosis. In 5 other patients the diagnosis was staged upw ard from localized to extended recurrent disease, and in 1 patient with an equivocal complete diagnostic work-up, PET correctly excluded malignancy. Conclusion: FDG-PET allows a highly sensitive diagnosis and accurate whole- body staging of symptomatic recurrent esophageal cancer. Further studies in asymptomatic patients are needed to assess the potential benefit on surviv al.