IMPROVEMENT IN STAGING OF ESOPHAGEAL CANCER WITH THE ADDITION OF POSITRON-EMISSION-TOMOGRAPHY

Background. Positron emission tomography with the glucose analogue 2-[ F-18]fluoro-2-deoxy-D-glucose (FDG) has been used to detect and stage a variety of malignancies, We hypothesized that FDG-positron emission tomography would improve staging of patients with esophageal cancer an d thereby facilitate selection of candidates for resection. Methods. F ifty-eight patients (42 men and 16 women) with biopsy-proven Esophagea l cancer were evaluated with both FDG-positron emission tomography and computed tomography. Results. In all but 2 patients, increased FDG up take was identified at the site of the primary tumor. Six patients wer e not operative candidates. Seventeen patients were not candidates for resection because of metastatic disease. Positron emission tomography identified the metastatic disease in all 17 (12 of whom underwent con firmatory biopsy), whereas computed tomography was positive for metast ases in only 5. The remaining 35 patients underwent surgical explorati on, were judged to have resectable disease and had esophagectomy. Path ologic examination of resected specimens identified lymph node metasta ses in 21 patients. These nodes were detected by positron emission tom ography in 11 patients and by computed tomography in 6. Conclusions. P osition emission tomography improved staging and facilitated selection of patients for operation by detecting distant disease not identified by computed tomography alone.