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AIM: To evaluate the role of PET/CT as an additional staging modality in oesophageal cancer.PATIENTS AND METHODS: 46 consecutive patients with potentially curable oesophageal cancer underwent PET/CT as part of primary staging after conventional staging with CT, +/- endoscopic ultrasound (EUS), +/- staging laparoscopy and discussion at the regional multidisciplinary team meeting (MDT). Data was collected prospectively between 1st May and 1st November 2009.RESULTS: Patients included 32 males, 14 females, median age 68 years (range 44-86 years). 29 had adenocarcinoma, 15 squamous carcinoma and 2 undifferentiated carcinoma. All had previous CT and, 32 (68%) had EUS and 19 (41%). Staging prior to PET-CT was recorded as: T1/2 N0 = 5; T3 N0 = 7; T1/2 N1 = 9; T3 N1 = 21; T4 N0/1 = 4. Staging following these investigations was recorded and compared to findings at PET/CT. There were 8 (17%) examinations reported positive for metastatic disease. 6 (13%) patients had metastatic disease not identified on previous staging. 2 patients had confirmation of metastatic disease after suspicion was raised on previous investigation. Other previously undiagnosed cancers were seen in 2 cases: 1 confirmed breast cancer and 1 advanced oropharygeal cancer. In 13 of 31 (42%) cases, PET/CT understaged nodal disease reported as N1 on previous staging. 2/46 (4%) with negative PET/CT were later identified to have metastatic disease (false negatives). 27 patients post PET-CT proceeded to radical treatment (neo-adjuvant chemotherapy + surgery in 18; radical chemo-radiotherapy in 9). 19 patients proceeded to palliative treatment. CONCLUSION: We conclude that PET/CT is a highly important staging modality in oesophageal carcinoma. Treatment plans were changed from potentially curable to palliative in 10 (22%) with metastatic disease identified in 8/46 (17%) of patients previously thought possible candidates for radical treatment after conventional imaging with CT +/- EUS +/- laparoscopy. PET/CT showed a relatively poor correlation with conventional staging for nodal disease with 13/31 (42%) of patients with local nodal disease after conventional staging understaged as node negative.