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Invited Commentary
June 2015

Indications and Limitations in the Management Algorithm of Patients With Esophageal AdenocarcinomaPositron Emission Tomography Computed Tomography

Author Affiliations
  • 1Department of Surgery, Boston Veterans Affairs Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, West Roxbury, Massachusetts
JAMA Surg. 2015;150(6):562. doi:10.1001/jamasurg.2015.0392

Staging of patients with esophageal cancer includes a computed tomography (CT) scan of the chest, abdomen, and pelvis and an upper endoscopy with endoscopic ultrasound. Positron emission tomography (PET) CT has been increasingly used to rule out metastatic disease, detect recurrent disease after treatment, or predict the response to treatment. While PET CT is valuable in identifying metastatic and recurrent disease, its role in the initial staging of the disease is limited because it cannot reliably identify the T stage or invasion to locoregional lymph nodes. Furthermore, evidence supporting the role of PET CT in predicting the response to treatment is limited. Research studies are mostly retrospective, comprise small samples with different cancer histotypes, and use different PET CT measurement units. Hence, studies like that of Kukar et al,1 aimed to standardize patient populations as well as PET CT measurements and assessments, stimulate significant interest.

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