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September 2002

Positron Emission Tomography in the Initial Staging of Esophageal Cancer

Author Affiliations

From the Departments of Surgery (Dr Wren and Mr Stijns) and Medical Oncology (Dr Srinivas), Palo Alto Veterans Health Care System, Palo Alto, Calif, and Stanford University School of Medicine, Stanford, Calif.

Arch Surg. 2002;137(9):1001-1006. doi:10.1001/archsurg.137.9.1001

Objective  To assess the value of positron emission tomography (PET) compared with computed tomography (CT) in the initial staging of esophageal cancer.

Design  Case series.

Setting  Tertiary care veterans hospital.

Patients  Patients with newly diagnosed esophageal cancers from January 1996 through May 2001 who underwent both CT and PET scanning within 4 weeks were included in the study (n = 24). Only patients who underwent pathological or radiographic follow-up were included.

Main Outcome Measures  The sensitivity, specificity, and negative and positive predictive values of CT and PET were determined based on a criterion standard of pathological staging in 16 patients (67%) and follow-up imaging in 8 patients (33%).

Results  For staging regional lymph node involvement, CT and PET scans showed no statistically significant difference in sensitivity (57% and 71%, respectively) and specificity (71% and 86%, respectively). For detection of metastatic disease, CT and PET showed no significant difference in sensitivity (83% and 67%, respectively) and specificity (75% and 92%, respectively). There was no significant difference in clinical decision making when the results of both tests were discordant.

Conclusions  There was no significant difference between the 2 imaging modalities in the initial staging of esophageal cancer. The CT scan was a sensitive indicator of distant metastases, whereas PET was more specific. It is unclear what additional role PET scanning should have in the initial screening of patients.