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Integrated PET/CT Fusion Imaging and Endoscopic Ultrasound in the Pre-operative Staging and Evaluation of Esophageal Cancer

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Abstract

Purpose

Accurate staging of esophageal cancer (ECA) is critical in determining appropriate therapy. Endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography (PET) scanning can be used, but limited data exists regarding the use of combined PET/CT fusion imaging and EUS in ECA staging. The objective of this study is to evaluate the role of integrated PET/CT imaging and EUS in the staging of ECA.

Procedures

Identification of patients diagnosed with ECA from 2004 to 2007 that underwent staging PET/CT and EUS. Data regarding tumor detection, lymph node identification, presence of metastatic disease, and affect on patient management were collected and compared between PET/CT and EUS.

Results

Eighty-one patients (65 male, 16 female) were identified with mean age of 63.5 years who underwent EUS and PET/CT to stage known ECA. PET/CT identified the primary tumor in 74/81 (91.4%) of cases, compared to 81/81 (100%) with EUS. Locoregional adenopathy was seen by PET/CT in 29/81 (35.8%) of cases, compared to 49/81 (60.5%) by EUS (p = 0.0001). PET/CT identified celiac axis adenopathy in 8/81 (9.9%) of cases, compared to 11/81 (13.6%) with EUS (p = 0.5050). PET/CT identified 17/81 (21.0%) of patients with distant metastases who subsequently did not undergo attempt at curative surgical resection.

Conclusions

In ECA, EUS is superior to PET/CT for T staging and in identifying locoregional nodes, while PET/CT provides M staging. EUS and integrated PET/CT appear to independently affect treatment decisions, indicating complimentary and necessary roles in the staging of ECA.

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Abbreviations

CAX:

Celiac axis

CT:

Computed tomography

ECA:

Esophageal cancer

EGD:

Esophagogastroduodenoscopy

EUS:

Endoscopic ultrasound

FNA:

Fine needle aspiration

M:

Metastasis

N:

Nodes

PET:

Positron emission tomography

T:

Tumor

XRT:

Radiotherapy

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Authors and Affiliations

  1. Department of Medicine, University of Wisconsin Hospital and Clinics, H6/516d Clinical Science Center 600 Highland Avenue, Madison, WI, 53792-5124, USA

    Andrew J. Walker, Bret J. Spier, Jason R. Stangl, Terrence J. Frick, Deepak V. Gopal & Patrick R. Pfau

  2. Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Scott B. Perlman

  3. Department of Thoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Tracey L. Weigel

  4. Department of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Mary J. Lindstrom

Authors
  1. Andrew J. Walker
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  2. Bret J. Spier
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  3. Scott B. Perlman
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  4. Jason R. Stangl
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  5. Terrence J. Frick
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  6. Deepak V. Gopal
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  7. Mary J. Lindstrom
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  8. Tracey L. Weigel
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  9. Patrick R. Pfau
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Corresponding author

Correspondence to Patrick R. Pfau.

Additional information

Manuscript Category and Significance

This is an original article describing the complimentary and necessary use of PET/CT combined with EUS in the pre-treatment staging of esophageal cancer.

Disclosure/Conflict of Interest

None of the authors have any disclosures or conflicts of interest to make.

Funding

None

Author’s Contributions

Andrew J. Walker: data collection and drafting of the manuscript

Bret J. Spier: drafting and submission of the manuscript

Scott B. Perlman: data collection and nuclear medicine physician associated with the project, editing, and final approval of the manuscript.

Jason R. Stangl: data collection

Terrence J. Frick: data collection and final approval of the manuscript

Deepak V. Gopal: data collection, editing, and final approval of the manuscript

Mary J. Lindstrom: statistical analysis

Tracey L. Weigel: data collection, editing, and final approval of the manuscript

Patrick R. Pfau: data collection, editing, and final approval of the manuscript

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Walker, A.J., Spier, B.J., Perlman, S.B. et al. Integrated PET/CT Fusion Imaging and Endoscopic Ultrasound in the Pre-operative Staging and Evaluation of Esophageal Cancer. Mol Imaging Biol 13, 166–171 (2011). https://doi.org/10.1007/s11307-010-0306-0

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  • DOI: https://doi.org/10.1007/s11307-010-0306-0

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