Purpose To observe the clinical application value of 68Ga-FAPI-04 PET/CT in the preoperative detection of lymph node metastasis and staging of esophageal cancer.Methods A prospective analysis of 29 surgical patients was performed. 68Ga-FAPI-04 PET/CT was performed within 1 week before the operation. All patients received enhanced CT during the same period. None of these patients had received preoperative treatment before the operation. The value of 68Ga-FAPI-04 PET/CT and enhanced CT in the diagnosis of lymph node metastasis and preoperative staging of esophageal cancer was compared according to postoperative pathology.Results Both 68Ga-FAPI-04 PET/CT and CT detected the primary tumor (29/29 cases). 637 lymph nodes were surgically removed, of which 37 lymph nodes were metastasized. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for lymph node metastasis detection were 71.1%, 99.4%, 97.8%, 90.0%, and 98.2%; The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for lymph node metastasis detection were 36.8%, 98.9%, 95.3%, 70.0%, and 96.1%, respectively.Conclusion 68Ga-FAPI-04 PET/CT is better than enhanced CT in diagnosing lymph node metastasis and determining lymph node staging in esophageal cancer.