Skip to main content
SpringerLink
Log in

FDG-PET scanning in the management of cancer of the oesophagus and oesophagogastric junction: Early experience with 100 consecutive cases

  • Original Paper
  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Abstract

Background

The aim was to evaluate the impact of FDG-PET scan on tumour staging and management decisions in oesophageal cancer.

Methods

One-hundred consecutive patients referred for consideration of surgery underwent a whole body FDG-PET scan in addition to CT imaging.

Results

Based on CT scan, a curative approach could be considered in 62 patients.The PET scan altered regional nodal (N) staging in 16 patients overall, but did not alter management decisions. Metastatic status (M) was increased in 14 patients, with altered management in 10/62 (16%). Nine were downstaged, with management changed in 3/38 (8%). Seventeen patients underwent 19 additional tests to clarify findings on PET, in 15 patients (88%) the tests revealed no pathology

Conclusion

FDG-PET alters M stage in 23% of patients and may impact on surgical decision-making.The spurious investigations and cost of the high false-positive rate of further tests is of concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Enzinger PC, Mayer RJ. Esophageal Cancer.N. Engl J Med, 2003;349:562–572

    Article  Google Scholar 

  2. Hulscher JB, Tijssen, Obertop H, van Lanschot JJ. Transthoracic versus transhiatial resection for carcinoma of the esophagus: A meta-analysis.Ann Thorac Surg 2001; 72:306–13

    Article  CAS  PubMed  Google Scholar 

  3. Beahrs OH, Henson DE, Hunter RVP, et al: American Joint Committee on Cancer: Manual for staging of cancer (ed 3). Philadelphia, PA, JB Lippincott, 1998,99 63–67.

    Google Scholar 

  4. Sobin LH, Wittekind C: TNM Classification of Malignant Tumours, 6th ed. New York: John Wiley & Sons, 2003.

    Google Scholar 

  5. Kumbasar B. Carcinoma of esophagus: radiologic diagnosis and staging.EurJ Radiol 2002; 42:170–180.

    Article  Google Scholar 

  6. Kelly S, Harris KM, Berry E,et al A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma.Gut 2001; 49; 534–9.

    Article  CAS  PubMed  Google Scholar 

  7. Bar-Shalom R, Valdiva AY, Blaufox MD. PET imaging in oncology.Semin Nucl Med 2000; 30:150–85.

    Article  CAS  PubMed  Google Scholar 

  8. Lightdale CJ. Positron emission tomography: Another useful test for staging esophageal cancer.J Clin Oncol 2000; 18:3199–01.

    CAS  PubMed  Google Scholar 

  9. Lewis P, Griffin S, Marsden P,et al Whole body F-fluorodeoxyglucose positron emission tomography in the preoperative evaluation of lung cancer.Lancet 1994; 344:1265–1266.

    Article  CAS  PubMed  Google Scholar 

  10. Adler LP, Crowe JP, Al-Kaisi NK,et al Evaluation of breast masses and axillary lymph nodes with (F-18) 2-deoxy-2-fluoro-d-glucose PET.Radiol 1993; 187:743–750.

    CAS  Google Scholar 

  11. Rege S, Maass A, Chaiken L,et al Use of positron emission tomographywith fluoro-deoxyglucose in patients with extracranial head and neck tumors. Cancer 1994; 74:3047–3058.

    Article  Google Scholar 

  12. Newman JS, Francis IR, Kaminski MS,et al Imaging of lymphoma with PET with 2-(F-18)-fluoro-2-deoxy-D-glucose: correlation with CT.Radiol 1994; 190:111–116.

    CAS  Google Scholar 

  13. Di Chiro G. Positron emission tomography using (F-18)fluorodeoxyglucose in brain tumors. A powerful diagnostic and prognostic tool.Invest Radiol 1987; 22:360–371.

    Article  PubMed  Google Scholar 

  14. Steinert HC, Huch RA, Buck A,et al Malignant melanoma: staging with whole body positron emission tomography and 2-(F-18)-fluoro-2-deoxy-D-glucose.Radiol 1995; 195:705–709.

    CAS  Google Scholar 

  15. Nieweg OE, Pruim J, van Ginkel RJ,et al Fluorine-18-fluorodeoxyglucose PET in soft tissue sarcomaJ Nucl Med 1996; 37:257–261

    CAS  PubMed  Google Scholar 

  16. Henderik L, van Westreenen MD, Heeren PAM, van Dullemen HM,et al Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations.J Gastrointest. Surg 2005; 9:54–61.

    Article  Google Scholar 

  17. Wallace MB, Nietert PJ, Earle C,et al An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography and thoracoscopy/laparoscopy.Ann Thorac Surg 2002; 74:1026–32.

    Article  PubMed  Google Scholar 

  18. Kato H, Hiroyuki K, Nakajima M,et al Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma.Cancer 2002; 94:921–928.

    Article  PubMed  Google Scholar 

  19. Kim K, Park SJ, Kim BT, Lee KS, Shim YM. Evaluation of lymph node metastases in squamous cell cancer of the esophagus with positron emission tomograpgy.Ann Thorac Surg. 2001; 71:290–294.

    Article  CAS  PubMed  Google Scholar 

  20. Wren SM, Stijns P, Srinivas S. Positron emission tomography in the initial staging of esophageal cancer.Arch Surg. 2002; 137:1001–1007.

    Article  PubMed  Google Scholar 

  21. Luketich JD, Friedman DM, Weigel TL,et al Evaluation of distant metastases in esphageal cancer: 100 consecutive positron emission tomography scans.Ann Thorc Surg 1999; 68:1133–7.

    Article  CAS  Google Scholar 

  22. Eloubeidi MA, Wallace MB, Reed CE,et al The utility of EUS and EUS-guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: A single center experience.Castrointest. Endosc. 2001:54:714–9.

    Article  CAS  Google Scholar 

  23. Parmar KS, Zwischenberger JB, Reeves AL, Waxman I. Clinical impact of endoscopic ultrasound-guided fine needle aspiration of celiac axis lymph nodes (M1a disease) in esophageal cancer.Ann Thorac Surg 2002; 73:916–20.

    Article  PubMed  Google Scholar 

  24. Meno KV, Dehn TC. Multiport staging laporoscopy in esophageal and cardiac carcinoma.Dis Esophagus 2003; 16:295–300.

    Article  Google Scholar 

  25. Jamieson GG, Mathew G, Ludeman R, Wayman J, Myers JC, Devitt PG. Postoperative mortality following esophagectomy and problems in reporting its rate.Br J Surg 2004; 91:943–97

    Article  CAS  PubMed  Google Scholar 

  26. Ellis FH Jr., Heatley GJ, Krasna MJ, Williamson WA, Balogh K. Esophagogastrectomy for carcinoma of the esophagus and cardia: A comparison of findings and results after standard resection in three consecutive eight-year intervals with improved staging criteriaJ Thorac Cardiovasc Surg 1997; 113:836–46.

    Article  PubMed  Google Scholar 

  27. Flamen P, Lerut A, Van Cutesm E,et al: Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma.J Clin Oncol 2000; 18:3202–10.

    CAS  PubMed  Google Scholar 

  28. Warburg O. On the origin of cancer cells.Science 1956;123:309–14.

    Article  CAS  PubMed  Google Scholar 

  29. Wahl RL, Hutchins GD, Buchsbaum DJ,et al (F-18)-2-deoxy-2-fluoro-d-glucose uptake into human tumor xenografts. Feasibility studies for cancer imaging with positron emission tomography.Cancer 1991; 67:1544–50.

    Article  CAS  PubMed  Google Scholar 

  30. Block Ml, Patterson GA, Sundaresan S,et al Improvement in staging of oesophageal CA with the addition of positron emission tomography.Ann Thorac Surg 1997; 64:770–7

    Article  CAS  PubMed  Google Scholar 

  31. Fukahagan T, Okazumi S, Koide Y, Zsoho K, Zwnazeki K. Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET.J Nucl Med 1998;39:1002–7.

    Google Scholar 

  32. Flanagan FL, Dehdashti F, Seigel BA,et al Staging of esophageal cancer with (F-18)fluorodeoxyglucose postron emission tomography.AJR 1997:168:417–24.

    CAS  PubMed  Google Scholar 

  33. MRC Trial. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: A randomised controlled trial.Lancet 2002; 359:1727–1733

    Article  Google Scholar 

  34. Fiochha F, DiBona D, Schepis F, Licata A, Shahied L,et al Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis.Gut 2004; 53:925–930.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept of Clinical Surgery, St James’s Hospital, Ireland

    V. Malik, M. Keogan, C. Gilham, G. Duffy, N. Ravi & J. V. Reynolds

  2. Dept of Radiology, St James’s Hospital, Ireland

    M. Keogan

  3. Dept of Radiotherapy, St James’s Hospital, Ireland

    C. Gilham

  4. Trinity College Dublin & Dept of Nuclear Medicine, Blackrock Clinic, Dublin

    G. Duffy

Authors
  1. V. Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Keogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Gilham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Ravi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. V. Reynolds
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. V. Reynolds.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Malik, V., Keogan, M., Gilham, C. et al. FDG-PET scanning in the management of cancer of the oesophagus and oesophagogastric junction: Early experience with 100 consecutive cases. Ir J Med Sci 175, 48–54 (2006). https://doi.org/10.1007/BF03167967

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03167967

Keywords

Search

Navigation