Pitfalls of positive findings in staging esophageal cancer with F-18-fluorodeoxyglucose positron emission tomography

Ann Surg Oncol. 2003 Nov;10(9):1100-5. doi: 10.1245/aso.2003.03.005.


Background: 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET) is valuable in staging of esophageal cancer. However, FDG-PET may falsely upstage patients leading to incorrect exclusion from surgical treatment. This study was performed to determine the false-positive rate and possible causes.

Methods: The rate of false-positive lesions on FDG-PET was documented in 86 out of a group of 98 patients. Lesions were defined as false positive when pathological examination was negative or as absence of tumor activity within 6 months of follow-up. To evaluate the influence of a learning curve on the false-positive rate, the PET scans were revised recently.

Results: False-positive lesions were found in 13 patients (13 of 86; 15%). FDG-PET incorrectly revealed only locoregional node metastases in 5 patients in whom surgery with curative intent was performed. Ten lesions in the other 8 patients were classified as distant organ or as nonregional node metastases (M1a/1b). Finally, 5 patients upstaged to M1a/1b underwent a curative resection. The number of false-positive lesions decreased from 16 to 5 (6%) after revision.

Conclusions: Proper interpretation of FDG-PET in staging esophageal cancer is impeded by false-positive results. Even after completion of the learning curve, positive FDG-PET findings still have to be confirmed by additional investigations.

Publication types

  • Clinical Trial

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / pathology*
  • Adult
  • Aged
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / pathology*
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / pathology*
  • False Positive Reactions
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Staging / methods*
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Tomography, Emission-Computed


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18