Top

Published in:

01-11-2005 | Original Article

Comparison of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasound in the Initial Staging of Patients with Esophageal Cancer

Authors: Val J. Lowe, MD, Fargol Booya, MD, J. G. Fletcher, MD, Mark Nathan, MD, Eric Jensen, MD, Brian Mullan, MD, Eric Rohren, MD, PhD, Maurits J. Wiersema, MD, Enrique Vazquez-Sequeiros, MD, Joseph A. Murray, MD, Mark S. Allen, MD, Michael J. Levy, MD, Jonathan E. Clain, MD

Published in: Molecular Imaging and Biology | Issue 6/2005

Abstract

Introduction

Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic ultrasound (EUS) in the staging of esophageal carcinoma were compared.

Methods

PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer. Either tissue confirmation or fine needle aspiration (FNA) was used as the gold standard of disease. Sensitivity and specificity for tumor, nodal, and metastatic (TNM) disease for each test were determined. TNM categorizations from each test were used to assign patients to subgroups corresponding to the three treatment plans that patients could theoretically receive, and these were then compared.

Results

Local tumor staging (T) was done correctly by CT and PET in 42% and by EUS in 71% of patients (P value > 0.14). The sensitivity and specificity for nodal involvement (N) by modality were 84% and 67% for CT, 86% and 67% for EUS, and 82% and 60% for PET (P value > 0.38). The sensitivity and specificity for distant metastasis were 81% and 82% for CT, 73% and 86% for EUS, and 81% and 91% for PET (P value > 0.25). Treatment assignment was done correctly by CT in 65%, by EUS in 75%, and by PET in 70% of patients (P value > 0.34).

Conclusions

EUS had superior T staging ability over PET and CT in our study group. The tests showed similar performance in nodal staging and there was a trend toward improved distant disease staging with CT or PET over EUS. Assignment to treatment groups in relation to TNM staging tended to be better by EUS. Each test contributed unique patient staging information on an individual basis.

Goldberg M, Farma J, Lampert C et al. (2003) Survival following intensive preoperative combined modality therapy with paclitaxel, cisplatin, 5-fluorouracil, and radiation in resectable esophageal carcinoma: A phase I report. J Thorac Cardiovasc Surg 126(4):1168–1173CrossRefPubMed

Saltzman JR (2003) Section III: Endoscopic and other staging techniques. Semin Thorac Cardiovasc Surg 15(2):180–186CrossRefPubMed

Lerut T, Coosemans W, Decker G et al. (2004) Extended surgery for cancer of the esophagus and gastroesophageal junction. J Surg Res 117(1):58–63CrossRefPubMed

Rice TW (2000) Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin North Am 10(3):471–85

van Westreenen HL, Westerterp M, Bossuyt PM et al. (2004) Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22(18):3805–3812CrossRefPubMed

Wallace MB, Nietert PJ, Earle C et al. (2002) An analysis of multiple staging management strategies for carcinoma of the esophagus: Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg 74(4):1026–1032CrossRefPubMed

Rosh T, (1994) Endoscopic ultrasonography. Endoscopy 26:148–168PubMedCrossRef

Wiersema MJ, Giovannini VPM, Chang KJ, Wiersema LM (1997) Endosonography-guided fine-needle aspiration biopsy: Diagnostic accuracy and complication assessment. Gastroenterology 112:1087–1095PubMedCrossRef

Lerut T, Flamen P, Ectors N et al. (2000) Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: A prospective study based on primary surgery with extensive lymphadenectomy. Ann Surg 232(6):743–752CrossRefPubMed

10.

Kneist W, Schreckenberger M, Bartenstein P, Grunwald F, Oberholzer K, Junginger T (2003) Positron emission tomography for staging esophageal cancer: does it lead to a different therapeutic approach? World J Surg 27(10):1105–1112CrossRefPubMed

11.

Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT (2004) Detection of distant metastases in esophageal cancer with (18)F-FDG PET. J Nucl Med 45(6):980–987PubMed

Title: Comparison of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasound in the Initial Staging of Patients with Esophageal Cancer
Authors: Val J. Lowe, MD
Fargol Booya, MD
J. G. Fletcher, MD
Mark Nathan, MD
Eric Jensen, MD
Brian Mullan, MD
Eric Rohren, MD, PhD
Maurits J. Wiersema, MD
Enrique Vazquez-Sequeiros, MD
Joseph A. Murray, MD
Mark S. Allen, MD
Michael J. Levy, MD
Jonathan E. Clain, MD
Publication date: 01-11-2005
Publisher: Springer-Verlag
Published in: Molecular Imaging and Biology / Issue 6/2005
Print ISSN: 1536-1632
Electronic ISSN: 1860-2002
DOI: https://doi.org/10.1007/s11307-005-0017-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasound in the Initial Staging of Patients with Esophageal Cancer

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2005

Population Pharmacokinetic Analysis for Simultaneous Determination of B max and K D In Vivo by Positron Emission Tomography

Uptake of a Fluorescent Deoxyglucose Analog (2-NBDG) in Tumor Cells

Small Animal Imaging Center Design: The Facility at the UCLA Crump Institute for Molecular Imaging

Translational Neuroimaging: Positron Emission Tomography Studies of Monoamine Oxidase

2-Deoxy-2-[F-18]fluoro-D-glucose-Positron Emission Tomography in Characterization of Solid Renal Masses

Myeloperoxidase Activity Imaging Using 67Ga Labeled Substrate