The imaging modalities commonly used for the diagnosis and staging of esophageal cancer are upper GI study, endoscopy, endoscopic ultrasound, CT, and PET.
PET is superior to CT and EUS combined in diagnosing stage IV disease. NCCN recommends PET for preoperative staging only, not for restaging. While the studies on detection of distant disease suggest better diagnostic performance for PET over CT, the available body of evidence is small. Only one study clearly avoided verification bias, only one clearly interpreted PET blind to the reference standard, and none clearly interpreted the reference standard blind to PET. Various TEC Assessments have not recommended PET for restaging. More recently ESMO says in the same vein : “Moreover, PET (or PET-CT) may be helpful in identifying otherwise undetected distant metastases [II, B]“. Other recent articles support PET for restaging.
John F. Bruzzi, FFRRCSI, Reginald F. Munden, MD, Mylene T. Truong, MD, Edith M. Marom, MD, Bradley S. Sabloff, MD, Gregory W. Gladish, MD, Revathy B. Iyer, MD, Tin-Su Pan, PhD, Homer A. Macapinlac, MD and Jeremy J. Erasmus, MD PET/CT of Esophageal Cancer: Its Role in Clinical Management, 2007 RadioGraphics, 27, 1635-1652.
NCCN, Esophageal ESOPH-18, 2016
M. Stahl, C. Mariette, K. Haustermans, A. Cervantes, D. Arnold Oesophageal Cancer: ESMO Clinical Practice Guidelines, Ann Oncol 2013; 24 (Suppl 6): vi51-vi56.
Flamen P, Van Cutsem E, Lerut A, Cambier JP, Haustermans K, Bormans G, De Leyn P, Van Raemdonck D, De Wever W, Ectors N, Maes A, Mortelmans L. Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol. 2002 Mar;13(3):361-8.
Wong R, Walker-Dilks C. PET imaging in esophageal cancer: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 27 p. (Recommendation report – PET; no. 4). [44 references]
Sun L, Su XH, Guan YS, Pan WM, Luo ZM, Wei JH, Zhao L, Wu H. Clinical usefulness of 18F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy. World J Gastroenterol. 2009 Apr 21;15(15):1836-42.