Annals of Surgical Oncology

, Volume 10, Issue 8, pp 954–960 | Cite as

Prospective Analysis of Accuracy of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

  • Jari V. Räsänen
  • Eero I. T. Sihvo
  • M. Juhani Knuuti
  • Heikki R. I. Minn
  • Markku E. S. Luostarinen
  • Pekka Laippala
  • Tapio Viljanen
  • Jarmo A. SaloEmail author
Original Articles


Background: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities.

Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS).

Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients.

Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.

Key Words

Adenocarcinoma Esophagus Esophagogastric junction Positron emission tomography Staging 


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  1. 1.
    Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993;104:510–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998;83:2049–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Sihvo EI, Salminen JT, Rämö OJ, Salo JA. The epidemiology of oesophageal adenocarcinoma: has the cancer of gastric cardia an influence on the rising incidence of oesophageal adenocarcinoma? Scand J Gastroenterol 2000;35:1082–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Masurin VS, Ryndin VD, Efimov ON, Allahverdjian AS. Surgery of localized cardioesophageal cancer. Semin Surg Oncol 1992;8:33–6.PubMedGoogle Scholar
  5. 5.
    Rahamim J, Cham CW. Oesophagogastrectomy for carcinoma of the oesophagus and cardia. Br J Surg 1993;80:1305–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Steup WH, De Leyn P, Deneffe G, Van Raemdonck D, Coosemans W, Lerut T. Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification. J Thorac Cardiovasc Surg 1996;111:85–94, discussion 94–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Siewert JR, Stein HJ, Feith M, Bruecher BL, Bartels H, Fink U. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg 2001;234:360–7, discussion 368–9.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Ajani JA, Komaki R, Putnam JB, et al. A three-step strategy of induction chemotherapy then chemoradiation followed by surgery in patients with potentially resectable carcinoma of the esophagus or gastroesophageal junction. Cancer 2001;92:279–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Lew JI, Gooding WE, Ribeiro U Jr, Safatle-Ribeiro AV, Posner MC. Long-term survival following induction chemoradiotherapy and esophagectomy for esophageal carcinoma. Arch Surg 2001;136:737–42, discussion 743.CrossRefPubMedGoogle Scholar
  11. 11.
    Stein HJ, Feith M, Mueller J, Werner M, Siewert JR. Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 2000;232:733–42.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Richards DG, Brown TH, Manson JM. Endoscopic ultrasound in the staging of tumours of the oesophagus and gastro-oesophageal junction. Ann R Coll Surg Engl 2000;82:311–7.PubMedCentralPubMedGoogle Scholar
  14. 14.
    Vickers J. Role of endoscopic ultrasound in the preoperative assessment of patients with oesophageal cancer. Ann R Coll Surg Engl 1998;80:233–9.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Salminen JT, Färkkila MA, Rämö OJ, et al. Endoscopic ultrasonography in the preoperative staging of adenocarcinoma of the distal oesophagus and oesophagogastric junction. Scand J Gastroenterol 1999;34:1178–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Maerz LL, Deveney CW, Lopez RR, McConnell DB. Role of computed tomographic scans in the staging of esophageal and proximal gastric malignancies. Am J Surg 1993;165:558–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Botet JF, Lightdale CJ, Zauber AG, et al. Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT. Radiology 1991;181:426–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Reed CE, Mishra G, Sahai AV, Hoffman BJ, Hawes RH. Esophageal cancer staging: improved accuracy by endoscopic ultrasound of celiac lymph nodes. Ann Thorac Surg 1999;67:319–21, discussion 322.CrossRefPubMedGoogle Scholar
  19. 19.
    Collard JM. Role of videoassisted surgery in the treatment of oesophageal cancer. Ann Chir Gynaecol 1995;84:209–14.PubMedGoogle Scholar
  20. 20.
    Luketich JD, Schauer P, Urso K, et al. Minimally invasive surgical biopsy confirms PET findings in esophageal cancer. Surg Endosc 1997;11:1213–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Romijn MG, van Overhagen H, Spillenaar Bilgen EJ, Ijzermans JN, Tilanus HW, Lameris JS. Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma. Br J Surg 1998;85:1010–2.CrossRefPubMedGoogle Scholar
  22. 22.
    Pauwels EK, McCready VR, Stoot JH, van Deurzen DF. The mechanism of accumulation of tumour-localising radiopharmaceuticals. Eur J Nucl Med 1998;25:277–305.CrossRefPubMedGoogle Scholar
  23. 23.
    Strauss LG, Conti PS. The applications of PET in clinical oncology. J Nucl Med 1991;32:623–48, discussion 649–50.PubMedGoogle Scholar
  24. 24.
    Flanagan FL, Dehdashti F, Siegel BA, et al. Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 1997;168:417–24.CrossRefPubMedGoogle Scholar
  25. 25.
    Kole AC, Plukker JT, Nieweg OE, Vaalburg W. Positron emission tomography for staging of oesophageal and gastroesophageal malignancy. Br J Cancer 1998;78:521–7.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    McAteer D, Wallis F, Couper G, et al. Evaluation of 18F-FDG positron emission tomography in gastric and oesophageal carcinoma. Br J Radiol 1999;72:525–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Kim K, Park SJ, Kim BT, Lee KS, Shim YM. Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography. Ann Thorac Surg 2001;71:290–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Rankin SC, Taylor H, Cook GJ, Mason R. Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma. Clin Radiol 1998;53:659–65.CrossRefPubMedGoogle Scholar
  29. 29.
    Kobori O, Kirihara Y, Kosaka N, Hara T. Positron emission tomography of esophageal carcinoma using (11)C-choline and (18)F-fluorodeoxyglucose: a novel method of preoperative lymph node staging. Cancer 1999;86:1638–48.CrossRefPubMedGoogle Scholar
  30. 30.
    Lerut T, Flamen P, Ectors N, et al. Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy. Ann Surg 2000;232:743–52.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Sobin, LHWittekind, C eds. 1997TNM Classification of Malignant Tumors.5th ed.Wiley;New York:5458Google Scholar
  32. 32.
    Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-d-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986;27:235–8.PubMedGoogle Scholar
  33. 33.
    Fleiss, JL eds. 1981Statistical Methods for Rates and Proportions2nd ed.WileyNew York:Google Scholar
  34. 34.
    Dwyer AJ. Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology 1991;178:328–30.CrossRefPubMedGoogle Scholar
  35. 35.
    Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 2000;118:670–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Lonneux M, Borbath I, Bol A, et al. Attenuation correction in whole-body FDG oncological studies: the role of statistical reconstruction. Eur J Nucl Med 1999;26:591–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Flamen P, Lerut A, Van Cutsem 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.CrossRefPubMedGoogle Scholar
  38. 38.
    Vickers J, Alderson D. Influence of luminal obstruction on oesophageal cancer staging using endoscopic ultrasonography. Br J Surg 1998;85:999–1001.CrossRefPubMedGoogle Scholar
  39. 39.
    Luketich JD, Schauer P, Landreneau R, et al. Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 1997;114:817–21, discussion 821–3.CrossRefPubMedGoogle Scholar
  40. 40.
    Luketich JD, Friedman DM, Weigel TL, et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg 1999;68:1133–6, discussion 1136–7.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Jari V. Räsänen
    • 1
  • Eero I. T. Sihvo
    • 1
  • M. Juhani Knuuti
    • 2
  • Heikki R. I. Minn
    • 2
  • Markku E. S. Luostarinen
    • 3
  • Pekka Laippala
    • 4
  • Tapio Viljanen
    • 2
  • Jarmo A. Salo
    • 1
    • 5
    Email author
  1. 1.Division of General Thoracic and Esophageal SurgeryDepartment of Cardiothoracic Surgery, Helsinki University Central HospitalHelsinkiFinland
  2. 2.Department of Oncology and RadiotherapyTurku PET Center, University of TurkuTurkuFinland
  3. 3.Department of SurgeryPaijat-Hame Central HospitalLahtiFinland
  4. 4.School of Public HealthUniversity of Tampere and Research Unit, Tampere University HospitalTampereFinland
  5. 5.Division of General Thoracic and Esophageal SurgeryDepartment of Cardiothoracic Surgery, Helsinki University Central HospitalHelsinkiFinland

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