Impact of FDG-PET for staging of oesophageal cancer

Abstract

Our results demonstrated clearly the impact of the PET scan for decision-making in patients with oesophageal carcinoma. PET should be performed prior to therapy with curative intention. However, addition of a computed tomography scan of the neck might reduce the rate of unexpected metastases detected by PET.

Staging investigations for oesophageal cancer: a meta-analysis

“…In patients in whom distant metastases were detected with FDG-PET, the treatment plan was corrected from a curative to a palliative option and unnecessary surgery was precluded (Block et al, 1997;Flanagan et al, 1997;Kole et al, 1998;Rankin et al, 1998;Luketich et al, 1999;Flamen et al, 2000;Lerut et al, 2000;Wren et al, 2002;Imdahl et al, 2004;van Westreenen et al, 2005). Disadvantages of FDG-PET include the high costs and the fact that it mostly needs to be combined with CT to localise a lesion that is visualised by FDG-PET.…”

18F-FDG PET/CT Has a High Impact on Patient Management and Provides Powerful Prognostic Stratification in the Primary Staging of Esophageal Cancer: A Prospective Study with Mature Survival Data

“…This functional assessment of cancer with PET provides several advantages over morphologic assessment with CSI in a wide variety of cancers, including more accurate staging. This advantage is particularly true in esophageal cancer, with PET, compared with CSI, providing superior assessment of remote nodal and systemic metastatic disease (5)(6)(7)(8)(10)(11)(12)(13)(14). Such lesions are important to both treatment choice and delivery, with their detection contributing significantly to the observed rate of 18 F-FDG activity in the primary tumor and metastatic nodal disease in a periesophageal (red arrows) and a left gastric node (yellow arrows), which were not considered pathologically enlarged on prior staging dedicated CT. A left adrenal lesion was of indeterminate etiology on CT but was intensely 18 F-FDG-avid compatible with a distant metastasis (orange arrows).…”

“…Dedicated CT scans can assess local invasion of adjacent mediastinal structures as well as regional nodal enlargement and metastatic disease. However, this technique has been shown to be less sensitive for detection of regional nodal and distant metastatic disease, compared with 18 F-FDG PET, which has been shown to be of incremental value in the primary staging of esophageal cancer (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). PET provides more accurate staging, provides more accurate prognostic stratification, and can change management in more than one third of patients (4,6).…”

Supraclavicular lymph nodes in patients with esophogeal or gastric cardiac cancers: Imaging

“…In one study by Imdahl et al [7] in 2004, they reported that the most frequent site of metastases missed by CT and detected by PET was in cervical lymph nodes (38% of the total missed metastases). If sonography of the neck is utilized prior to resorting to the expensive PET scan, it is likely that the number of PET scans required will be diminished.…”