Positron Emission Tomography for Staging Esophageal Cancer: Does It Lead to a Different Therapeutic Approach?

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RESEARCH PRODUCT

Positron Emission Tomography for Staging Esophageal Cancer: Does It Lead to a Different Therapeutic Approach?

Mathias Schreckenberger Peter Bartenstein Katja Oberholzer Werner Kneist Theodor Junginger Frank Grünwald

subject

Male medicine.medical_specialty Esophageal Neoplasms Sensitivity and Specificity Preoperative care Metastasis Preoperative Care Humans Medicine Prospective Studies Esophagus Lymph node Aged Neoplasm Staging medicine.diagnostic_test business.industry Esophageal disease Carcinoma Reproducibility of Results Middle Aged Esophageal cancer medicine.disease medicine.anatomical_structure Positron emission tomography Lymphatic Metastasis Female Surgery Radiology Tomography X-Ray Computed business Tomography Emission-Computed Abdominal surgery

description

Accurate preoperative staging is essential for the indication and selection of the appropriate surgical procedure in patients with esophageal cancer. The present prospective study was designed to determine if the preoperative use of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) increases the accuracy of staging esophageal cancer compared with computed tomography (CT) and if it thereby leads to a different therapeutic approach. A total of 58 patients, 46 men and 12 women (mean age 61 years), with histologic proof of esophageal carcinoma underwent FDG-PET of the neck, chest, and abdomen, as well as CT of the chest and abdomen, to determine tumor stage. FDG-PET and CT data were compared with each other and with pathohistologic findings. Sensitivity, specificity, and overall accuracy for detecting histologically verified lymph node and distant metastases were calculated for FDG-PET and CT. FDG-PET showed a higher specificity, whereas CT had higher accuracy for detecting both abdominal (73% vs. 59%) and thoracic (73% vs. 63%) lymph node metastases. The accuracy of detecting blood-borne and lymphatic distant metastases was identical for CT and FDG-PET imaging (50%). FDG-PET had a higher specificity than CT (87% vs. 13%) but lower sensitivity (35% vs. 67%). FDG-PET did not provide new information on the indication for surgery, nor was it helpful for choosing the appropriate surgical procedure in patients with esophageal carcinoma. In view of the relatively high cost of FDG-PET examinations, the use of this modality is indicated primarily in patients with inconclusive CT findings or for scientific research projects. Higher sensitivity as a result of tumor-affinity radiopharmaceuticals and optimized apparatus resolution, in addition to the advantages offered by whole-body PET scanning, may lead to new indications for this staging procedure in the future.

year	journal	country	edition	language
2003-10-01	World Journal of Surgery

https://doi.org/10.1007/s00268-003-6921-z