Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer - 23/08/11
Reprint requests: Rajesh N. Keswani, MD, Division of Gastroenterology, 676 North St. Clair, Suite 14-016, Chicago, IL 60611.St. Louis, Missouri, USA
Abstract |
Background |
Although EUS-guided FNA (EUS-FNA) and 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) are both used in the staging of esophageal cancer, the utility of routinely performing both tests is unclear.
Objectives |
The primary aim of the study was to determine the benefit of routine FDG-PET for esophageal cancer nodal staging in patients undergoing EUS-FNA. The secondary objective was to determine EUS criteria that selectively identify patients in whom PET yields additional information.
Design |
Retrospective chart review.
Setting |
Tertiary-care academic medical center.
Patients and Interventions |
All patients who underwent both EUS and PET for initial staging of esophageal cancer between April 2003 and August 2007.
Main Outcome Measurements |
EUS and PET detection of malignant lymph nodes and distant metastases.
Results |
Of 242 patients who underwent esophageal EUS for a malignant indication, 148 also underwent PET within 30 days. EUS detected locoregional-node disease by EUS criteria or cytology in 92 patients, and PET was positive in a minority of these patients (n = 41 [45%]). For celiac-node staging, PET was positive in 2 of 17 patients (12%) with celiac-node involvement detected by EUS. EUS was also significantly more sensitive than PET in the detection of nodal disease confirmed by cytology or histology (86% vs 44%). PET did not alter nodal staging in any patient with complete EUS-FNA. PET identified distant metastases only in those patients with incomplete EUS or nodal disease detected by EUS.
Limitations |
Single institution, retrospective analysis.
Conclusions |
The addition of PET to a complete EUS examination did not alter regional-node or celiac-node staging. PET performance in overall staging is strongly associated with EUS assessment of lymph nodes.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : AJCC, EUS-FNA, FDG, PET
Mappa
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S. Edmundowicz: Receives research support and acts as a consultant for Olympus and receives grant and equipment support from Cook Endoscopy; D. Early, R. Azar: Received honoraria from Olympus and Cook Endoscopy. All other authors disclosed no financial relationships relevant to this publication. |
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| If you want to chat with an author of this article, you may contact him at rajman@gmail.com. |
Vol 69 - N° 7
P. 1210-1217 - giugno 2009 Ritorno al numero
Articolo precedente
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