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News

PET and CT in preoperative staging of esophageal carcinoma

Preoperative PET was not characterized by greater accuracy in the detection of metastatic sites previously identified by CT, reports October's issue of Archives of Surgery.

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Positron emission tomography (PET) is a useful tool in the selection of patients with esophageal cancer who may not benefit from esophageal resection.

Researchers from Germany included in the study, a total of 81 patients from a tertiary care hospital who had newly diagnosed esophageal cancer and had undergone PET and computer tomography (CT) of the chest and abdomen (and of the neck in 45 patients) within 45 days.

The researchers calculated the sensitivity and specificity in detecting metastatic sites on the basis of 31 histologically verified lesions.

In addition to results obtained on CT, the research team evaluated information provided by PET with a view to the choice of management strategies.

PET detected distant metastases that were not identified with CT in 10% of patients
Archives of Surgery

The researchers noted that the PET findings had a higher specificity (89% vs 11%) but a lower sensitivity (38% vs 63%) than CT findings in the detection of metastatic sites.

The CT results showed greater agreement with histopathological findings than did PET results.

The research team found that PET detected distant metastases that were not identified with CT in 8 patients (10%).

In addition, in 4 patients (5%), PET detected bone metastases only, but in all of these patients metastases in other locations were detected by CT.

Although PET led to upstaging (M1) in 2 patients (2%), it did not enable the exclusion of esophageal resection.

Dr Mathias Schreckenberger concluded, "Preoperative PET was not characterized by greater accuracy in the detection of metastatic sites previously identified by CT."

"Therefore, PET did not lead to a change in the indication for esophagectomy."

He commented, "An increase in the sensitivity and the combined use of CT and PET may lead to new indications for this staging procedure."

Archives of Surgery; 2004;139:1043-1049
29 October 2004

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