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Systematic Review of the Staging Performance of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography in Esophageal Cancer

From the Department of Surgery, Department of Nuclear Medicine/PET Center, and Office for Medical Technology Assessment, University Hospital Groningen, Groningen, the Netherlands; Department of Surgery, Department of Clinical Epidemiology and Biostatistics, and Department of Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands

Address reprint requests to J.Th.M. Plukker, MD, PhD, Department of Surgery, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; e-mail: j.th.plukker{at}chir.azg.nl

PURPOSE: Despite the increasing number of publications concerning ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) for staging of esophageal cancer and the increasing availability of this novel diagnostic modality, its exact role in preoperative staging of these tumors is still unknown. The aim of this study was to systematically review the literature regarding the diagnostic performance of FDG-PET in preoperative staging of patients with esophageal cancer, and to calculate summary estimates of its sensitivity and specificity.

METHODS: The databases of PubMed, Embase, and Cochrane were searched for relevant studies. Two reviewers independently assessed the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed.

RESULTS: Twelve studies met the inclusion criteria. The studies had several design deficiencies. Pooled sensitivity and specificity for the detection of locoregional metastases were 0.51 (95% CI, 0.34 to 0.69) and 0.84 (95% CI, 0.76 to 0.91), respectively. For distant metastases, pooled sensitivity and specificity were 0.67 (95% CI, 0.58 to 0.76) and 0.97 (95% CI, 0.90 to 1.0), respectively.

CONCLUSION: FDG-PET showed moderate sensitivity and specificity for the detection of locoregional metastases, and reasonable sensitivity and specificity in detection of distant lymphatic and hematogenous metastases.

This study was supported by ZonMw Program for Health Care Efficiency Research.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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