Improvement in Staging of Esophageal Cancer With the Addition of Positron Emission Tomography

Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma

“…20,21 Several authors have reported that FDG-PET shows greater sensitivity than CT in the diagnosis of involved regional lymph nodes and have suggested that PET may have a role as a staging modality in esophageal carcinoma. [12][13][14] One study showed that PET had a sensitivity, specificity, and accuracy for lymph nodes metastases of 92% (12/13), 88% (7/8), and 90% (19/21), respectively, compared with 38% (5/13), 100% (8/8), and 59% (13/22), respectively, for CT scanning. 14 Our findings on lymph node staging were very similar.…”

“…[7][8][9][10][11] Markedly increased FDG uptake in esophageal squamous cell carcinoma (SCC) has been documented in several studies, [12][13][14][15] and they have reported that PET using FDG shows greater sensitivity in the diagnosis of involved regional lymph nodes than computed tomography (CT). This suggests that PET may have a role in evaluating the stage of esophageal carcinoma.…”

“…[12][13][14] Most of these studies assessed the degree of accuracy with which PET detected metastasis in lymph nodes as a measure of lymph node staging. [12][13][14] Although it is important to ascertain in each patient if an esophageal carcinoma has spread to the lymph nodes at the time of surgery, it is more important to know the extent of regional spread. It is not yet certain how accurately FDG-PET can determine the spread of cancer to individual lymph nodes.…”

The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma

“…20 Preoperative FDG-PET imaging has led to the incidental detection of unsuspected distant metastases in Ͼ 20% of patients with esophageal carcinoma. 6,7,21,22 Accurate preoperative staging, particularly with regard to the depth of tumor invasion, lymph node involvement, and distant metastases, is vital in determining the most appropriate procedures for curative surgery for thoracic esophageal carcinoma. 23 Conventional anatomic imaging procedures, including CT, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), have been available for the preoperative staging of esophageal carcinoma; however, recent studies have reported on the efficacy of PET (particularly its improved accuracy relative to conventional imaging modalities) in this setting.…”

Value of baseline positron emission tomography for predicting overall survival in patient with nonmetastatic esophageal or gastroesophageal junction carcinoma

“…PET has been shown to improve the detection of Stage IV cancer and to improve diagnostic specificity in distant lymph node (LN) metastasis staging over conventional methods, such as CT and EUS. 2,3,9,11 Moreover, esophageal carcinoma patients who are responding to chemoradiation by PET have a significant correlation with pathologic response and survival. 9,[12][13][14] PET has been shown to be accurate and sensitive in detecting recurrent esophageal carcinoma as well.…”