Combined positron emission tomography and computed tomography (PET/CT) imaging in staging esophageal cancer - analysis of 12 cases

Positron emission tomography (PET) with the use of fluoride- 18- fluorodeoxyglucose (FDG) has become more and more popular in the diagnosis and treatment of neoplasms. When FDG-PET is combined with computed tomography (CT), diagnostic possibilities increase. The aim of this study was to retrospectively assess the clinical value of PET/CT fusion images, considering esophageal carcinoma staging. PET/CT images of the whole body were performed in 12 male patients, aged between 36 and 78 years (mean age: 59.1 years). Increased glucose utilization foci (FDG uptake) were noted in all patients. Increased focal FDG uptake beyond the limits of the esophagus was observed in the case of six patients, including two in the lungs, and five in the mediastinal, supraclavicular, cervical, epigastric and supraclavicular space lymph nodes. In the case of three patients subject to therapeutic resection procedures, two neoplastic lesion diagnoses observed during PET/CT examinations were confirmed by means of intraoperative and postoperative histopathological examinations. In the case of the third patient, the diagnosis proved falsely negative, considering regional lymph nodes metastases. In four cases, the PET/CT examination was insufficient, considering the depth of esophageal wall infiltration and/or presence of regional lymph nodes metastases. Based on the PET/CT examination, five patients were diagnosed with stage IV esophageal carcinoma. In the case of three patients, the PET/CT examination result leads towards upstaging. The PET/CT examination is of great value in the determination of the clinical stage of esophageal carcinoma. The use of PET/CT increases the efficacy of distant lymph nodes and internal organ metastases diagnosis. In selected patients, the above-mentioned examination, changes the staging of esophageal carcinoma, and thus, therapeutic options. When evaluating the depth of esophageal wall and mediastinal lymph nodes infiltration, the PET/CT examination is probably of lesser clinical value. Considering patients qualified towards surgical intervention, the evaluation of the stage of esophageal cancer by means of the PET/CT examination might bring about measurable benefits.