Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography.

OBJECTIVE: The objective of this study was to assess the performance of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in the staging of cancer in patients with esophageal carcinoma. MATERIALS AND METHODS: The findings of FDG PET and of CT in the chest and upper abdomen of 36 patients with newly diagnosed esophageal carcinoma were compared with pathologic findings obtained either during a curative surgical procedure with tissue sampling (n = 29) or by tissue sampling alone (n = 7). RESULTS: Abnormal FDG uptake was identified on PET in the esophageal tumors of all patients. In 29 patients who underwent curative esophagectomy, PET and CT accurately revealed the extent of nodal disease in 76% (22/29) and 45% (13/29) of patients, respectively. In the seven patients who underwent tissue sampling instead of complete esophagectomy, PET revealed metastatic disease in five patients, all of whom avoided needless surgery. CT failed to reveal metastatic disease in these five patients. In addition, PET incidentally revealed an unsuspected primary long carcinoma in one patient. CONCLUSION: FDG PET is more sensitive than CT for revealing regional and distant metastases in patients with esophageal carcinoma. The use of PET in the staging of esophageal cancer may prove to be cost-effective by decreasing the number of unnecessary surgeries in patients with unresectable tumors.

Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and computed tomography.

BACKGROUND: This study evaluates the clinical value of positron emission tomography (PET) with 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) as compared to computed tomography (CT) in patients with suspected recurrent or metastatic colorectal cancer (CRC). METHODS: A retrospective review of the records of 58 patients who had FDG-PET for evaluation of recurrent or advanced primary CRC was performed. FDG-PET results were compared with those of CT and correlated with operative and histopathologic findings, or with clinical course and autopsy reports. RESULTS: Recurrent or advanced primary CRC was diagnosed in 40 and 11 patients, respectively. The sensitivity and specificity of FDG-PET were 91% and 100% for detecting local pelvic recurrence, and 95% and 100% for hepatic metastases. These values were superior to CT, which had sensitivity and specificity of 52% and 80% for detecting pelvic recurrence, and 74% and 85% for hepatic metastases. FDG-PET correctly identified pelvic recurrence in 19 of 21 patients; CT was negative in 6 of these patients and equivocal in 4. FDG-PET was superior to CT in detecting multiple hepatic lesions and influenced clinical management in 10 of 23 (43%) patients. CONCLUSION: FDG-PET is more sensitive than CT in the clinical assessment of patients with recurrent or metastatic CRC, and provides an accurate means of selecting appropriate treatment for these patients.

Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18]fluoro-2-deoxy-D-glucose.

PURPOSE: To assess the ability of positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) to allow differentiation of benign from malignant intraosseous lesions. MATERIALS AND METHODS: Twenty patients with strictly intraosseous lesions (five benign and 15 malignant [three primary and 12 metastatic]) were studied with FDG PET. The final diagnosis was confirmed with histopathologic examination in all patients. The uptake of FDG within each lesion was evaluated qualitatively as well as semiquantitatively by determination of the standardized uptake value (SUV). RESULTS: SUV assessment of FDG accumulation within osseous lesions was superior to subjective visual analysis for discriminating benign from malignant lesions. With use of a 2.0 cutoff value for SUV, 14 of 15 malignant lesions were categorized correctly versus 12 of 15 correctly categorized by means of subjective image evaluation; four of five benign lesions were categorized correctly with both techniques. CONCLUSION: FDG PET can aid in differentiating benign from malignant strictly intraosseous lesions.