Impact of integrated PET/CT in the staging of oesophageal cancer—a UK population-based cohort study

Noble, F.; Bailey, D.; SWCIS Upper Gastrointestinal Tumour Panel,; Tung, K.; Byrne, J.P.

doi:10.1016/j.crad.2009.03.003

« Previous Next »Clinical Radiology
Volume 64, Issue 7 , Pages 699-705, July 2009

Impact of integrated PET/CT in the staging of oesophageal cancer—a UK population-based cohort study

F. Noble
- Department of Surgery, Southampton University Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
- Guarantor and correspondence: F. Noble & J.P. Byrne, Department of Surgery, Southampton University Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD.
D. Bailey
- Cancer Analysis Team, South West Cancer Intelligence Service, South West Public Health Observatory, West Dean, Wiltshire, UK
SWCIS Upper Gastrointestinal Tumour Panel
- Cancer Analysis Team, South West Cancer Intelligence Service, South West Public Health Observatory, West Dean, Wiltshire, UK
K. Tung
- Department of Radiology, Southampton University Hospital, Southampton, Hampshire, UK
J.P. Byrne
- Department of Surgery, Southampton University Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
- Cancer Analysis Team, South West Cancer Intelligence Service, South West Public Health Observatory, West Dean, Wiltshire, UK
- Guarantor and correspondence: F. Noble & J.P. Byrne, Department of Surgery, Southampton University Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD.

Received 3 December 2008; received in revised form 25 March 2009; accepted 29 March 2009.

Aim

To document the impact of integrated positron-emission tomography and computed tomography (PET/CT) on the management of a cohort of UK patients undergoing PET/CT as part of their staging investigations for potentially curable oesophageal cancer.

Materials and methods

A multicentre, prospective study of newly diagnosed patients with oesophageal cancer undergoing PET/CT was set up across five cancer networks covering a total population of 6.6 million. Data were prospectively collected for cases diagnosed between 1 November 2006 and 31 October 2007.

Results

One hundred and ninety-one patients underwent PET/CT, with 31 (16%) positive for possible metastatic disease. Amongst the 31 positive examinations, 18 (9.4%) were confirmed to have metastatic disease, and 13 (6.5%) patients had no subsequent evidence of metastatic disease, although in three (1.6%) of these a second previously unsuspected pathology was diagnosed. Two patients had false-negative PET/CT and were found to have metastatic disease. The results of the PET/CT examination down-staged 10 (5%) patients thought to have coeliac/M1a node involvement on CT. Fifteen of 110 (13%) patients with stage 3 or 4 disease at CT and endoscopic ultrasound (EUS) had confirmed metastatic disease at PET/CT, compared with none of 18 with stage 2b, three of 52 (6%) with stage 2a, and none of 10 with stage 1 disease.

Conclusion

This study confirms the role of PET/CT in a multicentre UK setting in the management of patients with potentially curable carcinoma of the oesophagus, improving the accuracy of pre-treatment staging compared with CT and EUS alone. Early tumours infrequently show evidence of metastasis on PET/CT, although further data are required to confidently determine the stage of tumours where PET/CT has no additional value.