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 lung 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.