Thus, although CT can detect metastases in the setting of esophageal cancer, it has been found to be less sensitive than PET and FDG-PET/CT even when combined with esophageal US. The described literature presented here is based on contrast-enhanced CT. There are no reliable studies reporting the use of CT without IV contrast. When CT is used in the initial staging of esophageal cancer, contrast is recommended for optimal performance. CT Chest, Abdomen, and Pelvis For the purposes of this document, CT examinations are considered as being performed with IV contrast. Including the pelvis in CT for esophageal cancer would not affect the performance of CT for locoregional staging. The studies presented above by Heeren et al [11] and Hocazade et al [12] for the evaluation of systemic metastatic disease used CT of the chest and abdomen only. There are no studies that directly compare CT of the chest and abdomen with CT of the chest, abdomen, and pelvis; thus, the utility or added value of including the pelvis for the initial staging of esophageal cancer is not known. FDG-PET/CT Skull Base to Mid-Thigh Although there have been many studies evaluating the use of FDG-PET/CT in the evaluation of the primary tumor for prognosis, data supporting its use for T and N staging are limited. Walker et al [13] prospectively evaluated 81 patients with esophageal cancer with FDG-PET/CT and esophageal US and determined that esophageal US was superior to FDG-PET/CT for T staging and identifying locoregional lymph nodes. Hsu et al [14] investigated the use of PET/CT in 45 patients undergoing surgical resection for esophageal cancer and found that the maximum standardized uptake value (SUV)max showed potential in differentiating T1 from higher T stage tumors. In the same Staging and Follow-up of Esophageal Cancer study, however, the sensitivity, specificity, and accuracy of PET/CT for nodal involvement were 57.1%, 83.3%, and 71.1%, respectively.
Staging and Follow up of Esophageal Cancer. Thus, although CT can detect metastases in the setting of esophageal cancer, it has been found to be less sensitive than PET and FDG-PET/CT even when combined with esophageal US. The described literature presented here is based on contrast-enhanced CT. There are no reliable studies reporting the use of CT without IV contrast. When CT is used in the initial staging of esophageal cancer, contrast is recommended for optimal performance. CT Chest, Abdomen, and Pelvis For the purposes of this document, CT examinations are considered as being performed with IV contrast. Including the pelvis in CT for esophageal cancer would not affect the performance of CT for locoregional staging. The studies presented above by Heeren et al [11] and Hocazade et al [12] for the evaluation of systemic metastatic disease used CT of the chest and abdomen only. There are no studies that directly compare CT of the chest and abdomen with CT of the chest, abdomen, and pelvis; thus, the utility or added value of including the pelvis for the initial staging of esophageal cancer is not known. FDG-PET/CT Skull Base to Mid-Thigh Although there have been many studies evaluating the use of FDG-PET/CT in the evaluation of the primary tumor for prognosis, data supporting its use for T and N staging are limited. Walker et al [13] prospectively evaluated 81 patients with esophageal cancer with FDG-PET/CT and esophageal US and determined that esophageal US was superior to FDG-PET/CT for T staging and identifying locoregional lymph nodes. Hsu et al [14] investigated the use of PET/CT in 45 patients undergoing surgical resection for esophageal cancer and found that the maximum standardized uptake value (SUV)max showed potential in differentiating T1 from higher T stage tumors. In the same Staging and Follow-up of Esophageal Cancer study, however, the sensitivity, specificity, and accuracy of PET/CT for nodal involvement were 57.1%, 83.3%, and 71.1%, respectively.