Identification of distant metastases precludes attempt at curative resection in patients with esophageal carcinoma. Preoperative staging with computed tomography (CT) of the chest and abdomen has an overall accuracy of ∼55%. The purpose of the present study was to determine the additive efficacy of PET in the identification of occult metastases in patients with potentially resectable esophageal carcinoma based on CT imaging.
Between July 2002 and April 2004, patients with carcinoma of the esophagus underwent preoperative staging with PET in addition to routine CT of the chest and abdomen. All suspicious (FDG-avid) supraclavicular nodes identified on PET were confirmed cytologically by fine needle aspiration (FNA).
Thirty-three patients with potentially resectable esophageal carcinoma by CT staging of the chest and abdomen had preoperative PET performed at our institution. Their histologies were as follows: adeno (n=25), squamous cell (n=7), and poorly differentiated (n=1) carcinoma. Three of 25 patients with adenocarcinoma (12%) had occult supraclavicular nodal metastases identified only on PET; all confirmed cytologically by FNA. Mediastinal (n=2), bony (n=2), liver (n=1), & soft tissue (n=1) metastases were identified by PET, but not CT, in 6 additional patients. Overall, 24% of patients with potentially resectable esophageal carcinoma by CT staging were determined to be inoperable after PET imaging. In 32% of patients with “resectable” adenocarcinoma of the esophagus, PET identified distant metastases.
Esophageal carcinoma is frequently a systemic disease at presentation. Pre-operative staging with PET identified occult disease in ∼1/4 of all patients with esophageal carcinoma and ∼1/3 of those with adenocarcinoma. Supraclavicular nodal metastases are common in these patients and poorly evaluated by chest CT alone. FNA is useful in confirming metastases suggested on PET.
Preoperative PET can identify occult metastases in a significant number of patients with esophageal carcinoma deemed operable by routine CT imaging of the chest and abdomen. These data suggest that PET may enhance preoperative CT staging and alter treatment planning of patients with esophageal carcinoma.
J.L. Bobadilla, None.