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

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Abstract

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.

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Authors and Affiliations

  1. Department of Surgical Oncology, Groningen University Hospital, The Netherlands

    Henderik L. van Westreenen MD, Pierre A. M. Heeren MD & John Th. M. Plukker MD, PhD

  2. Nuclear Medicine/PET-center, Groningen University Hospital, The Netherlands

    Pieter L. Jager MD, PhD

  3. Gastroenterology, Groningen University Hospital, The Netherlands

    Hendrik M. van Dullemen MD, PhD

  4. Office for Medical Technology Assessment, Groningen University Hospital, The Netherlands

    Henk Groen MD, PhD

  5. Department of Surgical Oncology, University Hospital Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands

    John Th. M. Plukker MD, PhD

Authors
  1. Henderik L. van Westreenen MD
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  2. Pierre A. M. Heeren MD
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  3. Pieter L. Jager MD, PhD
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  4. Hendrik M. van Dullemen MD, PhD
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  5. Henk Groen MD, PhD
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  6. John Th. M. Plukker MD, PhD
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Correspondence to John Th. M. Plukker MD, PhD.

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van Westreenen, H.L., Heeren, P.A.M., Jager, P.L. et al. Pitfalls of Positive Findings in Staging Esophageal Cancer With F-18-Fluorodeoxyglucose Positron Emission Tomography. Ann Surg Oncol 10, 1100–1105 (2003). https://doi.org/10.1245/ASO.2003.03.005

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  • DOI: https://doi.org/10.1245/ASO.2003.03.005

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