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Prospective Analysis of Accuracy of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

From the Division of General Thoracic and Esophageal Surgery (JVR, EITS, JAS), Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Oncology and Radiotherapy (MJK, HRIM, TV), Turku PET Center, University of Turku, Turku, Finland; Department of Surgery (MESL), Paijat-Hame Central Hospital, Lahti, Finland; and School of Public Health (PL), University of Tampere and Research Unit, Tampere University Hospital, Tampere, Finland.

Correspondence: Address correspondence and reprint requests to: Jarmo A. Salo, MD, PhD, Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, FIN-00029 HUS, Helsinki, Finland; Fax: 358-9-471-74479; E-mail: jarmo.salo{at}hus.fi

Background: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities.

Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS).

Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients.

Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.

Key Words: Adenocarcinoma • Esophagus • Esophagogastric junction • Positron emission tomography • Staging

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