Utility of Positron Emission Tomography for the Staging of Patients With Potentially Operable Esophageal Carcinoma

作者：Patrick Flamen, Antoon Lerut, Eric Van Cutsem, Walter De Wever, Marc Peeters, Sigrid G. Stroobants, Patrick J. Dupont, Guy M Bormans, Martin I. Hiele, Paul De Leyn, Dirk E. Van Raemdonck, Willy Coosemans, Nadine L.E.Y. Ectors, Karin M. Haustermans, Luc Mortelmans · 发表于：Journal of Clinical Oncology · 年份：2000 · DOI：10.1200/jco.2000.18.18.3202 · 被引用次数：575 · 研究领域：Esophageal Cancer Research and Treatment、Medical Imaging Techniques and Applications、Gastric Cancer Management and Outcomes

PURPOSE: A prospective study of preoperative tumor-node-metastasis staging of patients with esophageal cancer (EC) was designed to compare the accuracy of 18-F-fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) with conventional noninvasive modalities. PATIENTS AND METHODS: Seventy-four patients with carcinomas of the esophagus (n = 43) or gastroesophageal junction (n = 31) were studied. All patients underwent attenuation-corrected FDG-PET imaging, a spiral computed tomography (CT) scan, and an endoscopic ultrasound (EUS). RESULTS: FDG-PET demonstrated increased activity in the primary tumor in 70 of 74 patients (sensitivity: 95%). False-negative PET images were found in four patients with T1 lesions. Thirty-four patients (46%) had stage IV disease. FDG-PET had a higher accuracy for diagnosing stage IV disease compared with the combination of CT and EUS (82% v 64%, respectively; P: =.004). FDG-PET had additional diagnostic value in 16 (22%) of 74 patients by upstaging 11 (15%) and downstaging five (7%) patients. Thirty-nine (53%) of the 74 patients underwent a 2- or 3-field lymphadenectomy in conjunction with primary curative esophagectomy. In these patients, tumoral involvement was found in 21 local and 35 regional or distant lymph nodes (LN). For local LN, the sensitivity of FDG-PET was lower than EUS (33% v 81%, respectively; P: =.027), but the specificity may have been higher (89% v 67%, respectively; P: = not significant [NS]). For the assessment of regional...