The utility of FDG-PET in the preoperative staging of esophageal cancer

Accurate staging of esophageal cancer is important when determining which patients will potentially benefit from curative surgery. The aim of this study was to evaluate the incremental effect of 2‐fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) when used in addition to standard staging modalities. Patients referred to two surgeons in an Australian metropolitan teaching hospital with esophageal or esophago‐gastric junction malignancy between May 2002 and December 2006 were included. Patients who had undergone prereferral treatment with chemotherapy or radiotherapy were excluded. Patients undergoing resection for gastrointestinal stromal tumors or high‐grade dysplasia within Barrett's esophagus were also excluded. Clinical and non‐clinical data were recorded prospectively. Pretreatment staging included routine CT scan and selective endoscopic ultrasound (EUS). FDG‐PET was performed in patients judged to have curable disease on CT scanning and EUS. From a total of 130 eligible patients, 76 were judged to have curable disease on the basis of CT and EUS findings. Of these 76 patients, 19 (25%) were excluded from surgery due to additional information obtained from FDG‐PET. The addition of FDG‐PET to routine preoperative staging resulted in the exclusion from surgery of 19 (25%) patients who prior to the introduction of FDG‐PET would have undergone attempted resection. FDG‐PET should be performed in all patients under consideration for esophagogastric resection in order to avoid resection in patients with disseminated disease.