ROLE OF POSITRON-EMISSION-TOMOGRAPHY IN STAGING ESOPHAGEAL CANCER

Background. Conventional noninvasive staging of esophageal cancer is i naccurate. This study investigated the role of positron emission tomog raphy (PET) in staging esophageal cancer. Methods. Patients with poten tially resectable esophageal cancer were included. A whole-body PET sc an was acquired after injection of F-18-fluorodeoxyglucose and was eva luated for areas of increased focal uptake. Accuracy was determined by comparing PET with surgical staging. Results. Potentially resectable esophageal cancer was identified in 35 patients. Positron emission tom ography detected nine sites of distant metastases missed by convention al scanning, but one false-negative PET scan occurred in a patient wit h a 2-mm liver lesion. There were 11 false-negative PET scans for smal l, intracapsular local-regional nodal metastases (mean diameter 5.2 mm ; range 2 to 10 mm). For distant metastases, the sensitivity was 88%, the specificity was 93%, and the accuracy was 91%. For local-regional nodal metastases, the sensitivity was 45%, the specificity was 100%, a nd the accuracy was 48%. Conclusions. Positron emission tomography imp roved our ability to detect distant metastases missed by conventional noninvasive staging of esophageal cancer. Small local-regional nodal m etastases are not identified by current PET technology. Early use of P ET in the staging of patients with esophageal cancer could facilitate treatment planning and identifying unsuspected distant metastases in u p to 20% of patients with a negative metastatic survey by conventional staging.