TY - JOUR
T1 - Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer
AU - Keswani, Rajesh N.
AU - Early, Dayna S.
AU - Edmundowicz, Steven A.
AU - Meyers, Bryan F.
AU - Sharma, Akash
AU - Govindan, Ramaswamy
AU - Chen, Jiajing
AU - Kohlmeier, Cara
AU - Azar, Riad R.
N1 - Funding Information:
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.
PY - 2009/6
Y1 - 2009/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=67349161778&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2008.08.016
DO - 10.1016/j.gie.2008.08.016
M3 - Article
C2 - 19012886
AN - SCOPUS:67349161778
SN - 0016-5107
VL - 69
SP - 1210
EP - 1217
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 7
ER -