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Detection of Distant Metastases in Esophageal Cancer with ¹⁸F-FDG PET

¹ Department of Surgical Oncology, University Hospital of Groningen, Groningen, The Netherlands
² Department of Nuclear Medicine/PET Center, University Hospital of Groningen, Groningen, The Netherlands
³ Department of Radiology, University Hospital of Groningen, Groningen, The Netherlands
⁴ Department of Gastroenterology, University Hospital of Groningen, Groningen, The Netherlands
⁵ Department of Medical Statistics, University Hospital of Groningen, Groningen, The Netherlands

Standard staging of esophageal and gastroesophageal junction (GEJ) tumors substantially lacks accuracy. The aim of this study was to investigate whether the addition of PET with ¹⁸F-FDG is a valuable gain in the initial staging. Methods: Between January 1996 and January 2002, ¹⁸F-FDG PET was performed in 74 patients. Conventional staging included CT in all patients and well-performed endoscopic ultrasonography (EUS) in 52 patients. They were compared with ¹⁸F-FDG PET with pathology and follow-up of suspicious lesions as the gold standard. Results: PET identified 70 primary tumors (sensitivity, 95%). Sensitivity to identify locoregional metastases was highest for EUS (69%) but was not different for CT and PET (44% and 55%, respectively). PET was able to identify distant nodal disease in 71% (17/24 patients) compared with 29% (7/24 patients) after combined CT/EUS alone (P = 0.021). Sensitivity to detect distant nodal and systemic (M1) disease increased with PET (78% vs. 37%; P = 0.012). PET upstaged 15 patients (15/74; 20%) correctly as M1 disease, missed by CT/EUS, and correctly downstaged 4 patients (5%) from M1 to M0 disease. However, false upstaging and downstaging was encountered in 5 (7%) and 3 (4%) patients, respectively. Conclusion: PET improves the currently applied staging of esophageal and GEJ tumors, particularly by ameliorating the detection of M1 disease.

Key Words: esophageal cancer • ¹⁸F-FDG PET • upstaging

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