PT  - JOURNAL ARTICLE
AU  - Pierre A.M. Heeren
AU  - Pieter L. Jager
AU  - Fons Bongaerts
AU  - Hendrik van Dullemen
AU  - Wim Sluiter
AU  - John Th.M. Plukker
TI  - Detection of Distant Metastases in Esophageal Cancer with <sup>18</sup>F-FDG PET
DP  - 2004 Jun 01
TA  - Journal of Nuclear Medicine
PG  - 980--987
VI  - 45
IP  - 6
4099  - http://jnm.snmjournals.org/content/45/6/980.short
4100  - http://jnm.snmjournals.org/content/45/6/980.full
SO  - J Nucl Med2004 Jun 01; 45
AB  - 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.