Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: A prospective study based on primary surgery with extensive lymphadenectomy

Ann Surg. 2000 Dec;232(6):743-52. doi: 10.1097/00000658-200012000-00003.


Objective: To assess the value of positron emission tomography with 18fluorodeoxyglucose (FDG-PET) for preoperative lymph node staging of patients with primary cancer of the esophagus and gastroesophageal junction.

Summary background data: FDG-PET appears to be a promising tool in the preoperative staging of cancer of the esophagus and gastroesophageal junction. Recent reports indicate a higher sensitivity and specificity for detection of stage IV disease and a higher specificity for diagnosis of lymph node involvement compared with the standard use of computed tomography and endoscopic ultrasound.

Methods: Forty-two patients entered the prospective study. All underwent attenuation-corrected FDG-PET imaging of the neck, thorax, and upper abdomen, a spiral computed tomography scan, and an endoscopic ultrasound. The gold standard consisted exclusively of the histology of sampled nodes obtained by extensive two-field or three-field lymphadenectomies (n = 39) or from guided biopsies of suspicious distant nodes indicated by imaging (n = 3).

Results: The FDG-PET scan had lower accuracy for the diagnosis of locoregional nodes (N1-2) than combined computed tomography and endoscopic ultrasound (48% vs. 69%) because of a significant lack of sensitivity (22% vs. 83%). The accuracy for distant nodal metastasis (M+Ly), however, was significantly higher for FDG-PET than the combined use of computed tomography and endoscopic ultrasound (86% vs. 62%). Sensitivity was not significantly different, but specificity was greater (90% vs. 69%). The FDG-PET scan correctly upstaged five patients (12%) from N1-2 stage to M+Ly stage. One patient was falsely downstaged by FDG-PET scanning.

Conclusions: FDG-PET scanning improves the clinical staging of lymph node involvement based on the increased detection of distant nodal metastases and on the superior specificity compared with conventional imaging modalities.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery
  • Esophagogastric Junction / pathology*
  • Esophagogastric Junction / surgery
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis / diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Staging / methods*
  • Prospective Studies
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / surgery
  • Tomography, Emission-Computed / methods*


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18