Gastrointestinal Endoscopy
Volume 67, Issue 3 , Pages 402-409, March 2008

Is positron emission tomography useful in locoregional staging of esophageal cancer? Results of a multidisciplinary initiative comparing CT, positron emission tomography, and EUS

Current affiliations: Department of Medicine, University of Alberta Hospital (G.S.S.), Department of Radiation Oncology (D.S) and Department of Oncologic Imaging (E.P., A.M.), Cross Cancer Institute, Department of Surgery, Royal Alexandra Hospital (K.S.), Edmonton, Alberta, Canada

Received 29 March 2007; accepted 4 September 2007. published online 21 January 2008.

Edmonton, Alberta, Canada

Background

Various modalities including CT, positron emission tomography (PET), and EUS are being used for esophageal cancer staging.

Objective

We compared results of locoregional staging by CT, PET, and EUS with histologic staging.

Design

Retrospective chart review.

Setting

Tertiary referral center.

Patients and Interventions

Patients with esophageal cancer proven by endoscopy and biopsy underwent a CT scan of the chest and abdomen and a PET scan. Patients with no evidence of distant metastatic disease on CT and PET were referred for EUS for locoregional staging.

Main Outcome Measurement

The tumor size (T) and lymph node (N) stage as determined by EUS were compared with surgical pathology or EUS-guided FNA cytology. The results of N staging with CT, PET, and EUS were compared with surgical pathology or EUS-FNA cytology.

Results

Between May 2005 and April 2006, 29 patients (24 men, mean age 68 years) underwent EUS. EUS was successful in 25 of 29 patients (86%). There were no EUS-related complications. Eleven of 16 patients with available lymph node histologic study had confirmed metastasis. Nodal metastasis was correctly identified by CT in 6 of 11 patients, by PET in 4 of 11 patients, and by EUS in 10 of 11 patients. Overall accuracy for N staging was 69% for CT, 56% for PET, and 81% for EUS. Fifteen patients had confirmed T staging by surgical pathologic examination. The percentage of agreement for T staging between EUS and surgical pathology was 80% (12/15 patients).

Limitations

Single center, retrospective chart review.

Conclusion

EUS is safe and accurate for tumor and node staging in esophageal cancer. The combination of CT plus EUS appears to be accurate for locoregional staging in esophageal cancer.

Abbreviations: CCI, Cross Cancer Institute, FDG, 18F-fluorodeoxyglucose, NPV, negative predictive value, PET, positron emission tomography, PPV, positive predictive value, T and N, tumor and node, TNM, tumor, node, and metastasis staging system

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 Presented at the 71st annual scientific meeting of the American College of Gastroenterology, October 20-25, 2006, Las Vegas, Nevada, USA.

PII: S0016-5107(07)02668-5

doi:10.1016/j.gie.2007.09.006

Gastrointestinal Endoscopy
Volume 67, Issue 3 , Pages 402-409, March 2008

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