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Erschienen in:
01.04.2015 | Original Scientific Report
Positron Emission Tomography–Computed Tomography in Oesophageal Cancer Staging: A Tailored Approach
Erschienen in: World Journal of Surgery | Ausgabe 4/2015
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Background
Positron emission tomography–computed tomography (PET–CT) scanning is used routinely in the staging of oesophageal cancer to identify occult metastases not apparent on CT and changes the management in typically 3–18 % patients. The authors aim to re-evaluate its role in the management of oesophageal cancer, investigating whether it is possible to identify a group of patients that will not benefit and can safely be spared from this investigation.
Methods
Consecutive patients with oesophageal cancer undergoing PET–CT staging between 2010 and 2013 were identified from a specialist modern multidisciplinary team database. Without knowledge of the PET–CT result, patients were stratified into low-risk or high-risk groups according to the likelihood of identifying metastatic disease on PET–CT based on specified criteria routinely available from endoscopy and CT reports. Clinical outcomes in the two groups were investigated.
Results
In 383 undergoing PET–CT, metastatic disease was identified in 52 (13.6 %) patients. Eighty-three patients were stratified as low risk and 300 as high risk. None of the low-risk patients went on to have metastatic disease identified on PET–CT. Of the high-risk patients, 17 % had metastatic disease identified on PET–CT.
Conclusions
In one of the largest studies to date investigating the influence of staging PET–CT on management of patients with oesophageal cancer, the authors report a classification based on endoscopy/CT criteria is able to accurately stratify patients according to the risk of having metastatic disease. This could be used to avoid unnecessary PET–CT 22 % of patients, saving cost, inconvenience and reducing potential delay to definitive treatment in this group.