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Synchronous Primary Neoplasms Detected on ¹⁸F-FDG PET in Staging of Patients with Esophageal Cancer

¹ Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
² Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
³ Department of Nuclear Medicine/PET Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
⁴ Department of Gastroenterology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
⁵ Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
⁶ Department of Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

Because of improvements in diagnostic technology, the incidental detection of synchronous primary tumors during the preoperative work-up of patients with esophageal cancer has increased. The aim of this study was to determine the rate and clinical relevance of synchronous neoplasms seen on ¹⁸F-FDG PET in staging of esophageal cancer. Methods: From January 1996 to July 2004, 366 patients with biopsy-proven malignancy of the esophagus underwent ¹⁸F-FDG PET for initial staging. This series of patients was retrospectively reviewed for the detection of synchronous primary neoplasms. Results: Twenty synchronous primary neoplasms (5.5%) were identified in 366 patients. Eleven neoplasms were in the colorectum, 5 in the kidney, 2 in the thyroid gland, 1 in the lung, and 1 in the gingiva. One of the thyroid lesions and the lung lesion were erroneously interpreted as metastases, leading to incorrect upstaging of the esophageal tumor. Conclusion: ¹⁸F-FDG PET detected unexpected synchronous primary neoplasms in 5.5% of patients with esophageal cancer. Sites of pathologic ¹⁸F-FDG uptake should be confirmed by dedicated additional investigations before treatment, because synchronous neoplasms may mimic metastases.

Key Words: esophageal cancer • PET • synchronous neoplasms

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