Prospective Comparison of PET, CT and EUS in the Initial Staging of Esophageal Cancer Patients: Preliminary Results.
Abstracts
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INTRODUCTION: PET imaging has been shown to be accurate in staging high-grade malignancies. EUS and CT are accurate imaging techniques that are commonly used in staging esophageal cancer patients (PTs). We are presently recruiting PTs to a prospective trial comparing these three diagnostic modalities and we present our preliminary results in PTs with esophageal cancer. METHODS: PET, CT and EUS were performed in PTs (42) with newly diagnosed esophageal cancer. PET and CT were performed the day prior to EUS. From each independent study interpretation, a TNM staging classification was determined. All studies were blindly interpreted and data recorded without knowledge of the results of other studies; the only exception being that at the end of EUS the physician was given the CT and PET data in order to perform tissue sampling of any abnormalities described solely on PET or CT. Disease staging results were compared to FNA or surgical findings. RESULTS: All studies were in agreement relative to nodal (N) and metastatic (M) disease status in 14 PTs. EUS was unable to obtain M status in 7 PTs due to stenosis. False negative (FN) N or M results were seen on CT in 4 PTs, PET in 7 PTs and EUS in 11 PTs. The greatest contributors to FN results on EUS were liver and distant metastatic disease and on PET, celiac node metastasis. False positive (FP) N or M results were seen on CT in 5 PTs, PET in 2 PTs and EUS in 3 PTs. The greatest contributors to FP CT results were lesions in the liver or local nodal findings. Eight other findings are not yet pathologically confirmed. CONCLUSIONS: PET, CT and EUS all contribute useful information for the initial staging of PTs with esophageal cancer. Diagnosing distant disease appears to be the most frequent additive information that PET and CT can provide to EUS in these PTs. |
