Abstract
Positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose (FDG) was prospectively investigated as a means of detecting metastatic disease in patients with oesophageal tumours and compared with computerized tomography (CT), with the surgical findings as a gold standard. Twenty-six patients with a malignant tumour of the oesophagus or gastroesophageal junction underwent CT and PET of the chest and the abdomen. Seven patients underwent laparoscopy to establish resectability. Fifteen patients underwent laparotomy without prior laparoscopy. Four patients did not undergo surgery. The primary tumour was visualized in 81% of patients with CT and in 96% with PET. Neither CT nor PET were suited to assess the extent of wall invasion. Surgically assessed nodal status corresponded in 62% with CT and in 90% with PET. Distant metastases were found in five patients with CT and in eight with PET. The diagnostic accuracy of CT in determining resectability was 65% and for PET 88%. For CT and PET together this was 92%. The present study indicates that FDG-PET can be of importance for staging patients with oesophageal tumours. PET has a higher sensitivity for nodal and distant metastases and a higher accuracy for determining respectability than CT. PET and CT together would have decreased ill-advised surgery by 90%.
Highlights
Based on computerized tomography (CT), Endoscopic ultrasonography (EUS) and Positron emission tomography (PET) findings explorative laparoscopy or laparotomy was not performed in four patients
In a third patient multiple pulmonary metastases were seen, and in the fourth patient extensive local tumour invasion was visualized with CT and EUS, which was confirmed by PET (Figure 2)
Neither CT nor PET were suited to assess the extent of wall invasion, in some patients in whom surgery revealed a T4 tumour (n = 10), this was suggested with CT in two patients and with PET in four patients (Figure 2)
Summary
Correspondence to: AC Kole appropriate method for assessing nodal involvement at the coeliac axis, metastases in the right liver lobe and peritoneal dissemination - some improvement can be obtained with fine-needle aspiration cytology during EUS (Tio et al, 1989; Lightdale, 1992; Dittler and Siewer, 1993) - explorative laparoscopy or laparotomy to assess metastatic disease and to estimate the possibility of resecting the tumour with curative intent usually remains necessary. The current study was undertaken to investigate FDG-PET prospectively as a means of detecting metastatic disease in patients with oesophageal tumours and of comparing the reliability of diagnostic assessment of PET with CT, with the surgical and histological findings as a gold standard. It was made obvious by CT and EUS and confirmed by PET findings that surgery was no longer a therapeutic option, because of N2 or distant metastases.
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