Role of Positron Emission Tomography in Staging Esophageal Cancer

doi:10.1016/S0003-4975(97)00624-3

The Annals of Thoracic Surgery

Volume 64, Issue 3, September 1997, Pages 765-769

Presented at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.

https://doi.org/10.1016/S0003-4975(97)00624-3 Get rights and content

Abstract

Background. Conventional noninvasive staging of esophageal cancer is inaccurate. This study investigated the role of positron emission tomography (PET) in staging esophageal cancer.

Methods. Patients with potentially resectable esophageal cancer were included. A whole-body PET scan was acquired after injection of ¹⁸F-fluorodeoxyglucose and was evaluated 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 tomography detected nine sites of distant metastases missed by conventional scanning, but one false-negative PET scan occurred in a patient with a 2-mm liver lesion. There were 11 false-negative PET scans for small, 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%, and the accuracy was 48%.

Conclusions. Positron emission tomography improved our ability to detect distant metastases missed by conventional noninvasive staging of esophageal cancer. Small local-regional nodal metastases are not identified by current PET technology. Early use of PET in the staging of patients with esophageal cancer could facilitate treatment planning and identifying unsuspected distant metastases in up to 20% of patients with a negative metastatic survey by conventional staging.

Section snippets

Material and Methods

This was a retrospective study of all consecutive patients with potentially resectable esophageal cancer referred to the Thoracic Surgery Service at the University of Pittsburgh Cancer Institute between July 1995 and October 1996. Resectability was determined by conventional staging, which included computed tomography (CT) of the chest and abdomen, bone scan, and endoscopic ultrasound. Patients with limited local-regional metastases considered to have resectable disease by the thoracic surgeon

Results

Among 50 patients screened, potentially resectable esophageal cancer was identified in 35 patients. Of these 35 patients, 25 had a diagnosis of adenocarcinoma; 9, squamous cell carcinoma; and 1, a neuroendocrine tumor of the esophagus. Positron emission tomographic imaging identified the primary esophageal cancer in 97% of patients (Fig. 1). In 18 patients (51%), PET identified foci of increased FDG uptake outside the esophagus consistent with local-regional or distant metastatic disease. In

Comment

The incidence of adenocarcinoma of the esophagus is increasing at an alarming rate that exceeds that of all other gastrointestinal malignancies [6]. The 5-year survival rate with surgical intervention alone is approximately 30%, and no preoperative or postoperative regimen of chemotherapy, radiation therapy, or combination has proved superior to operation alone 7, 8. A criticism of previous trials including the randomized trials 9, 10published to date is that the pretreatment staging regimens

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It is important to note that the treatment paradigm and diagnostic capabilities for esophageal cancer have evolved considerably over the course of the last 30 years. For example, prior to the year 1999, only 1 patient in our data had an EUS prior to surgery and none of them had a preoperative PET scan [13, 14]. However, since 1999, we had 16 cases of M1 esophageal disease and 13 patients had staging EUS and 14 diagnostic PET scan.
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Original ArticlesRole of Positron Emission Tomography in Staging Esophageal Cancer

Abstract

Section snippets

Material and Methods

Results

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Eur J Cancer

A comparison of endoscopic ultrasound and minimally invasive surgical staging in esophageal cancer [Abstract]

Am J Gastroenterol

Original Articles
Role of Positron Emission Tomography in Staging Esophageal Cancer