Oral PresentationsImag Techr

Abstract

An accurate pretreatment staging is prerequisite for prognostication and treatment allocation of adenocarcinoma of the esophagus. We hypothesized that this staging would be improved by positron emission tomography (PET). Fifty-five patients suitable for radical esophageal resection were staged with PET, spiral computed tomography (CT), and endoscopic ultrasonography (EUS) and the results were compared with histopathology and with survival. The accuracy for detecting locoregional lymph node metastasis did not differ significantly between EUS (72%), PET (60%), and CT (58%). By adding PET to standard staging the accuracy of N-staging did not improve (P = 0.250). By adding PET to CT (P = 0.016) or to combined use of EUS and CT (P = 0.031) improved the accuracy of M-staging. Nineteen (35%) of the 55 patients had metastatic lesions. By combined use of CT and EUS, eight and by combined use of CT, EUS and PET 14 (P = 0.031) could be detected. In nodal disease without distant metastases, PET did not improve the prediction of survival. However, positive PET for distant metastasis by either positive EUS or CT predicts well the poor survival of these patients. The staging value of PET by itself in adenocarcinoma of the esophagus is limited because of low accuracy in nodal and the lack of specificity in distant disease. By adding PET to standard staging does, however, improve the detection of stage IV disease and the related poor survival.