195

IS PET NECESSARY FOR LOCOREGIONAL STAGING OF ESOPHAGEAL CANCER? RESULTS OF A REGIONAL, MULTI-DISCIPLINARY INITIATIVE COMPARING CT, PET AND EUS

G Sandha, D Severin, S McEwan, K Stewart
University of Alberta Hospital, Cross Cancer Institute and Royal Alexandra Hospital, Edmonton, Alberta

AIM: There is no established algorithm for esophageal cancer staging. Various modalities including CT, PET and EUS are being used. The role of PET for staging is not clear. This study aims to compare the results of CT, PET and EUS with surgical pathology as part of an esophageal cancer staging algorithm.
METHODS: The Cross Cancer Institute (CCI) and the University of Alberta, both in Edmonton, Alberta, have collaboratively initiated an esophageal cancer triage program. Patients with biopsy-proven esophageal cancer are referred to the CCI. Each patient undergoes a CT scan of the chest/abdomen and a PET scan. Patients with no evidence of metastatic disease are referred for EUS for locoregional staging. Appropriate patients undergo surgery with curative intent. The T and N stage as determined with EUS was compared retrospectively with surgical pathology or FNA biopsy. The results of N staging with CT, PET and EUS were compared with surgical pathology or FNA biopsy.
RESULTS: Since May 2005, 29 patients, with no evidence of distant metastasis on CT and PET, underwent EUS. There were 24 males. The mean age was 68 yrs (range 50-82 yrs). EUS was completed in 25/29 patients (86% success). There were no EUS-related complications. Sixteen patients had histologically proven lymph node metastasis. Sensitivity for N staging was 55% for CT, 36% for PET and 91% for EUS with specificity of 100% for CT and PET and 60% for EUS. Diagnostic accuracy was 69% for CT, 56% for PET and 81% for EUS. Fifteen patients had histologically proven T staging. The percentage of agreement between EUS and histology with respect to T staging was 80%. There was disagreement between EUS and histology by one T level in 2 patients and two T levels in 1 patient.
CONCLUSION: EUS is a safe and accurate modality for T and N staging in esophageal cancer. The combination of CT + EUS for locoregional staging appears comparable to PET + EUS. This suggests that the utility of PET in esophageal cancer may be limited to situations where EUS staging is not available (non-traversable malignant strictures).

PREVIOUS NEXT