PURPOSE: To review our experience and investigate the value of adding PET to CT and EUS with or without Fine Needle Aspiration (FNA) in the initial staging of patients with esophageal carcinoma and its impact on clinical decision making.
METHODS: Retrospective review of the charts of patients that had an EUS and PET for the initial staging of esophageal carcinoma within one month of each other at our institution from January 2003-December 2005.
RESULTS: Of the 225 patients diagnosed with esophageal carcinoma during the study period, 65 patients met the eligibility criteria. Based on EUS staging, 20 had N0 disease and 45 had N1 disease (25 confirmed by FNA and 4 at the time of surgery). In the 20 patients with N0 disease, PET was falsely positive in 2 patients. Both were pathologically negative by EUS-FNA and surgery. Of the 29 pathologically confirmed N1 patients, PET showed evidence of locoregional lymph node (LN) involvement in only 16 (55%). Two patients staged N1 by EUS without FNA were found to be N0 by PET and surgery. Both patients had only one LN noted on EUS measuring less then 6 mm. In pathologically confirmed N1 patients, the median size of the LN missed on PET was 11 mm (6-25 mm) compared to 18 mm (10-33 mm) for the PET positive patients (p=0.004). PET showed evidence of distant organ metastasis in only 2 of the 65 patients, both were also identified by CT. EUS-FNA confirmed one liver metastasis which was missed by PET and CT.
CONCLUSION: The data suggests that EUS with concurrent FNA is superior to PET in the locoregional staging of esophageal carcinoma. FDG-PET did not identify additional distant lesions and therefore, did not significantly alter the management of patients in this study.
CLINICAL IMPLICATIONS: EUS-FNA is essential in the staging of esophageal carcinoma. Additional prospective studies are needed to assess the utility and cost effectiveness of routinely obtaining a PET in the initial staging of patients with esophageal carcinoma.
DISCLOSURE: Vamsidhar Velcheti, None.