Annals of Surgical Oncology

, Volume 10, Issue 9, pp 1100–1105 | Cite as

Pitfalls of Positive Findings in Staging Esophageal Cancer With F-18-Fluorodeoxyglucose Positron Emission Tomography

  • Henderik L. van Westreenen
  • Pierre A. M. Heeren
  • Pieter L. Jager
  • Hendrik M. van Dullemen
  • Henk Groen
  • John Th. M. Plukker
Original Articles


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.

Key Words

Esophageal cancer Positron emission tomography 18-F-fluorodeoxyglucose False-positive findings 


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Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Henderik L. van Westreenen
    • 1
  • Pierre A. M. Heeren
    • 1
  • Pieter L. Jager
    • 2
  • Hendrik M. van Dullemen
    • 3
  • Henk Groen
    • 4
  • John Th. M. Plukker
    • 1
    • 5
  1. 1.Department of Surgical OncologyGroningen University HospitalThe Netherlands
  2. 2.Nuclear Medicine/PET-centerGroningen University HospitalThe Netherlands
  3. 3.GastroenterologyGroningen University HospitalThe Netherlands
  4. 4.Office for Medical Technology AssessmentGroningen University HospitalThe Netherlands
  5. 5.Department of Surgical OncologyUniversity Hospital GroningenGroningenThe Netherlands

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