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Clinical staging of patients with early esophageal adenocarcinoma: does FDG-PET/CT have a role?
[esophageal carcinoma]
Esophageal
carcinoma
is
a
significant
worldwide
health
problem
and
the
incidence
is
increasing
faster
than
that
of
any
other
malignancy
.
18
F-
2
-
deoxy-
D-
glucose
(
FDG
)
-
positron
emission
tomography
/
computed
tomography
(
PET
/
CT
)
is
important
in
the
management
of
patients
with
potentially
resectable
esophageal
cancer
and
is
useful
in
initial
staging
of
locally
advanced
cancer
and
after
neoadjuvant
therapy
.
The
purpose
of
this
study
is
to
determine
the
utility
of
FDG-PET
/
CT
in
the
clinical
staging
of
early
-
stage
esophageal
cancer
.
Subjects
in
this
retrospective
study
were
79
consecutive
patients
with
cTisN
0
(
high
-grade
dysplasia
)
and
cT
1
N
0
primary
esophageal
adenocarcinoma
diagnosed
by
endoscopy
and
endoscopic
ultrasound
biopsy
that
were
evaluated
with
preoperative
FDG-PET
/
CT
and
had
not
received
neoadjuvant
therapy
.
Seventh
edition
American
Joint
Committee
on
Cancer
cTNM
and
FDG-PET
/
CT
were
compared
with
postoperative
pTNM
staging
.
pT
1
was
subdivided
into
intramucosal
cancers
with
lamina
propria
or
muscularis
mucosa
invasion
(
pT
1
a
)
and
submucosal
cancers
(
pT
1
b
)
.
In
pT
staging
,
the
frequency
of
FDG
uptake
increased
with
increasing
pT
,
from
pT
1
a
21
of
39
(
53
.
8
%
)
to
pT
1
b
19
of
22
(
55
.
8
%
)
.
pTis
was
three
of
five
(
60
.
0
%
)
.
Similarly
,
the
maximum
standardized
uptake
value
of
FDG-avid
lesions
increased
with
increasing
pT
,
with
median
values
of
3
.
7
for
pTis
,
3
.
8
for
pT
1
a
and
4
.
2
for
T
1
b
.
In
cN
staging
,
FDG-PET
/
CT
was
negative
in
76
patients
and
positive
in
three
patients
.
All
three
patients
with
FDG-avid
nodes
on
FDG-PET
/
CT
were
negative
for
metastatic
disease
on
biopsy
.
In
12
patients
with
pN
1
and
in
one
patient
with
N
2
,
FDG-PET
/
CT
was
falsely
negative
.
Sensitivity
and
positive
predictive
value
for
pN
disease
were
0
%
and
accuracy
was
82
%
.
There
were
no
distant
metastases
.
In
cM
staging
,
FDG-PET
/
CT
was
falsely
positive
in
five
patients
(
FDG
avid
nodules
n
=
3
,
distant
nodal
metastasis
n
=
2
)
and
resulted
in
unwarranted
biopsy
in
four
patients
.
F
DG-PET
/
CT
is
not
useful
in
the
TNM
staging
of
primary
adenocarcinoma
of
the
esophagus
when
endoscopy
and
biopsy
indicate
cTis
and
cT
1
.
In
fact
,
FDGPET
/
CT
can
be
detrimental
to
patient
management
.
Because
regional
nodal
metastases
are
uncommon
and
distant
metastases
rare
,
and
as
FDG-PET
/
CT
can
result
in
inappropriate
clinical
care
,
FDG-PET
/
CT
should
not
be
performed
in
the
evaluation
of
early
-
stage
esophageal
cancer
.
Diseases
Validation
Diseases presenting
"potentially resectable esophageal cancer"
symptom
esophageal adenocarcinoma
esophageal carcinoma
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