Esophageal Cancer

PET/CT is approved by Medicare for use in staging, restaging and detecting recurrence in esophageal cancer. The power of PET/CT in staging is to find occult metastatic disease. For restaging, PET/CT is more sensitive and specific than anatomical based imaging.

An additional role for PET/CT is to assess response to therapy in either neoadjuctive therapy or chemotherapy for metastatic disease.

2004 Esophageal Cancer Statistics*

  • Estimated New Cases 14,250
  • Estimated New Deaths 13,300

*All cancer statistics obtained from the American Cancer Society’s Cancer Facts and Figures available at www.cancer.org.

Esophageal Cancer & FDG PET Imaging Statistics**

Table 1: Utility of PET Imaging in Esophageal Cancer Diagnosis (N=36)

  PET CT
Sensitivity 91% 79%

Table 2: Utility of PET Imaging in Esophageal Cancer Staging (N=31)

  PET CT
Sensitivity 86% 79%

Table 3: Utility of PET Imaging in Esophageal Cancer Recurrence (N=2244)

  PET CT
Sensitivity 79% 69%
Specificity 77% N/A
PPV 90% N/A
NPV 56% N/A
Accuracy 76% N/A

For this patient population there was a 31% change in the way the physician managed the patient’s disease based upon the results PET scan.

** Reprinted by permission of the Society of Nuclear Medicine from: Gambhir, Sanjiv S., Czernin, Johannes, Schwimmer, Judy, Silverman, Daniel H.S., Coleman, R. Edward, Phelps, Michael E. “A Tabulated Summary of the FDG PET Literature” J Nucl Med 2001 42: 1-93.

Case Study
Patient: 62yo male with new diagnosis of esophageal cancer. Staged by CT and EUS as N0. PET/CT was ordered to assess for distant metastatic disease.

Results: PET/CT revealed an occult metastatic foci in the liver. Patient was upstaged.