Molecular Imaging and Biology

, 7:422

Comparison of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasound in the Initial Staging of Patients with Esophageal Cancer

  • Val J. Lowe
  • Fargol Booya
  • J. G. Fletcher
  • Mark Nathan
  • Eric Jensen
  • Brian Mullan
  • Eric Rohren
  • Maurits J. Wiersema
  • Enrique Vazquez-Sequeiros
  • Joseph A. Murray
  • Mark S. Allen
  • Michael J. Levy
  • Jonathan E. Clain
Original Article

Abstract

Introduction

Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic ultrasound (EUS) in the staging of esophageal carcinoma were compared.

Methods

PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer. Either tissue confirmation or fine needle aspiration (FNA) was used as the gold standard of disease. Sensitivity and specificity for tumor, nodal, and metastatic (TNM) disease for each test were determined. TNM categorizations from each test were used to assign patients to subgroups corresponding to the three treatment plans that patients could theoretically receive, and these were then compared.

Results

Local tumor staging (T) was done correctly by CT and PET in 42% and by EUS in 71% of patients (P value > 0.14). The sensitivity and specificity for nodal involvement (N) by modality were 84% and 67% for CT, 86% and 67% for EUS, and 82% and 60% for PET (P value > 0.38). The sensitivity and specificity for distant metastasis were 81% and 82% for CT, 73% and 86% for EUS, and 81% and 91% for PET (P value > 0.25). Treatment assignment was done correctly by CT in 65%, by EUS in 75%, and by PET in 70% of patients (P value > 0.34).

Conclusions

EUS had superior T staging ability over PET and CT in our study group. The tests showed similar performance in nodal staging and there was a trend toward improved distant disease staging with CT or PET over EUS. Assignment to treatment groups in relation to TNM staging tended to be better by EUS. Each test contributed unique patient staging information on an individual basis.

Key words

Esophageal cancer State Imaging CT PET EUS 

Copyright information

© Academy of Molecular Imaging 2005

Authors and Affiliations

  • Val J. Lowe
    • 1
    • 2
  • Fargol Booya
    • 1
  • J. G. Fletcher
    • 1
  • Mark Nathan
    • 1
  • Eric Jensen
    • 1
  • Brian Mullan
    • 1
  • Eric Rohren
    • 1
  • Maurits J. Wiersema
    • 2
  • Enrique Vazquez-Sequeiros
    • 2
  • Joseph A. Murray
    • 2
  • Mark S. Allen
    • 3
  • Michael J. Levy
    • 2
  • Jonathan E. Clain
    • 2
  1. 1.Department of RadiologyMayo Clinic RochesterRochesterUSA
  2. 2.Department of GastroenterologyMayo Clinic RochesterRochesterUSA
  3. 3.Department of Thoracic SurgeryMayo Clinic RochesterRochesterUSA

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