Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer

BackgroundAlthough 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.ObjectivesThe 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.DesignRetrospective chart review.SettingTertiary-care academic medical center.Patients and InterventionsAll patients who underwent both EUS and PET for initial staging of esophageal cancer between April 2003 and August 2007.Main Outcome MeasurementsEUS and PET detection of malignant lymph nodes and distant metastases.ResultsOf 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.LimitationsSingle institution, retrospective analysis.ConclusionsThe 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.