Molecular Imaging and Biology

, Volume 13, Issue 1, pp 166–171

Integrated PET/CT Fusion Imaging and Endoscopic Ultrasound in the Pre-operative Staging and Evaluation of Esophageal Cancer

  • Andrew J. Walker
  • Bret J. Spier
  • Scott B. Perlman
  • Jason R. Stangl
  • Terrence J. Frick
  • Deepak V. Gopal
  • Mary J. Lindstrom
  • Tracey L. Weigel
  • Patrick R. Pfau
Research Article

DOI: 10.1007/s11307-010-0306-0

Cite this article as:
Walker, A.J., Spier, B.J., Perlman, S.B. et al. Mol Imaging Biol (2011) 13: 166. doi:10.1007/s11307-010-0306-0

Abstract

Purpose

Accurate staging of esophageal cancer (ECA) is critical in determining appropriate therapy. Endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography (PET) scanning can be used, but limited data exists regarding the use of combined PET/CT fusion imaging and EUS in ECA staging. The objective of this study is to evaluate the role of integrated PET/CT imaging and EUS in the staging of ECA.

Procedures

Identification of patients diagnosed with ECA from 2004 to 2007 that underwent staging PET/CT and EUS. Data regarding tumor detection, lymph node identification, presence of metastatic disease, and affect on patient management were collected and compared between PET/CT and EUS.

Results

Eighty-one patients (65 male, 16 female) were identified with mean age of 63.5 years who underwent EUS and PET/CT to stage known ECA. PET/CT identified the primary tumor in 74/81 (91.4%) of cases, compared to 81/81 (100%) with EUS. Locoregional adenopathy was seen by PET/CT in 29/81 (35.8%) of cases, compared to 49/81 (60.5%) by EUS (p = 0.0001). PET/CT identified celiac axis adenopathy in 8/81 (9.9%) of cases, compared to 11/81 (13.6%) with EUS (p = 0.5050). PET/CT identified 17/81 (21.0%) of patients with distant metastases who subsequently did not undergo attempt at curative surgical resection.

Conclusions

In ECA, EUS is superior to PET/CT for T staging and in identifying locoregional nodes, while PET/CT provides M staging. EUS and integrated PET/CT appear to independently affect treatment decisions, indicating complimentary and necessary roles in the staging of ECA.

Key words

Endoscopic ultrasoundPET/CTEsophageal cancer

Abbreviations

CAX

Celiac axis

CT

Computed tomography

ECA

Esophageal cancer

EGD

Esophagogastroduodenoscopy

EUS

Endoscopic ultrasound

FNA

Fine needle aspiration

M

Metastasis

N

Nodes

PET

Positron emission tomography

T

Tumor

XRT

Radiotherapy

Copyright information

© Academy of Molecular Imaging and Society for Molecular Imaging 2010

Authors and Affiliations

  • Andrew J. Walker
    • 1
  • Bret J. Spier
    • 1
  • Scott B. Perlman
    • 2
  • Jason R. Stangl
    • 1
  • Terrence J. Frick
    • 1
  • Deepak V. Gopal
    • 1
  • Mary J. Lindstrom
    • 4
  • Tracey L. Weigel
    • 3
  • Patrick R. Pfau
    • 1
  1. 1.Department of MedicineUniversity of Wisconsin Hospital and ClinicsMadisonUSA
  2. 2.Department of RadiologyUniversity of Wisconsin Hospital and ClinicsMadisonUSA
  3. 3.Department of Thoracic SurgeryUniversity of Wisconsin Hospital and ClinicsMadisonUSA
  4. 4.Department of Biostatistics and Medical InformaticsUniversity of Wisconsin Hospital and ClinicsMadisonUSA