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Prospective Evaluation of Positron Emission Tomography in the Preoperative Staging of Esophageal Carcinoma
Werner Kneist, MD;
Mathias Schreckenberger, MD, PhD;
Peter Bartenstein, MD, PhD;
Christian Menzel, MD, PhD;
Katja Oberholzer, MD;
Theodor Junginger, MD, PhD
Arch Surg. 2004;139:1043-1049.
Hypothesis Positron emission tomography (PET) is a useful tool in the selection of patients with esophageal cancer who may not benefit from esophageal resection.
Design Case series.
Setting Tertiary care hospital.
Patients Eighty-one patients with newly diagnosed esophageal cancer who underwent PET and computer tomography (CT) of the chest and abdomen (and of the neck in 45 patients) within 45 days were included.
Main Outcome Measures We 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 information provided by PET was evaluated with a view to the choice of management strategies.
Results 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. In 8 patients (10%), PET detected distant metastases that were not identified with CT. 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.
Conclusions 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. An increase in the sensitivity and the combined use of CT and PET may lead to new indications for this staging procedure.
From the Departments of General and Visceral Surgery (Drs Kneist and Junginger), Nuclear Medicine (Drs Schreckenberger and Bartenstein), and Radiology (Dr Oberholzer), Hospital of the Johannes Gutenberg-University, Mainz, Germany; and the Department of Nuclear Medicine, Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany (Dr Menzel).
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