FDG PET in Staging of Oesophageal Cancer - Results in 131 Patients

INTRODUCTION: Conventional staging with CT and endoscopic ultrasound is reported to inappropriately stage 18-29% of oesophageal cancer patients. Despite technical difficulties with FDG PET, studies to date suggest a benefit of this technology in more accurately staging oesophageal cancer.METHODS: From November 2002 to March 2005, 131 patients referred for primary staging of diagnosed oesophageal cancer (on endoscopy and biopsy) were prospectively evaluated using FDG PET. Whole body images were obtained on a GSO Philips Allegro PET scanner 45 minutes after injection of FDG. Demographic data, staging based on conventional imaging and the referring clinicians management plan were obtained pre-PET. Post-PET were compared with post-PET findings. Follow-up was obtained on a subgroup of 33 patients.RESULTS: In the cohort studied there was no significant change in T or N staging by FDG PET compared with conventional staging with CT and endoscopic ultrasound. There was however an increase of patients with definite/known metastatic disease from 7% pre-PET to 25% post-PET. In a sub-group of 33 patients with management plan follow up, 21% had a change in management which was actively pursued post-PET. CONCLUSION: FDG PET more accurately staged oesophageal cancer based on the detection of previously unknown metastatic disease. FDG PET did not change T or N staging compared with conventional staging. Finally FDG PET changed management in one out of 5 patients of a cohort subgroup. FDG PET should be considered as part of the standard staging algorithm for oesophageal cancer.