History:
51 year old male with biopsy-proven adenocarcinoma of the esophagus.
The patient was referred to Main Street Radiology for an
esophagram and whole-body PET scan.
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Figure
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Figure
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Figure
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Findings:
The air contrast esophagram (figure 1) demonstrates a polypoid mass
(arrow) in the mid-esophagus, compatible with carcinoma. Nodular
changes of the distal esophagus may represent superficial spread of
malignancy, esophagitis, or Barrett esophagus.
Coronal (figure 2) and sagittal (figure
3) PET images show a single hypermetabolic focus in the mid-esophagus
corresponding to the mass seen on the esophagram. Normal activity is
present within the distal esophagus, indicating absence of malignancy.
No distant metastases are evident on the PET scan.
Discussion:
Barrett esophagus represents replacement of squamous epithelium of the
esophagus by metaplastic columnar epithelium, secondary to chronic
gastroesophageal reflux. These patients have a 40-fold higher risk
than the general population in developing adenocarcinoma. Squamous
cell carcinoma typically represents greater than 90% of esophageal
cancers.
Accurate staging is crucial in patients
with esophageal cancer, due to the poor prognosis and risks involved
with extensive surgery. PET has been shown to be the most accurate
non-invasive imaging modality in detecting distant metastases (Am J
Roentgenol 1997; 168:417-424), superior to CT. Although not advocated
for use in screening, PET has also achieved nearly 100% sensitivity in
detection of the primary tumor in patients with known esophageal
cancer. Neither CT nor PET has shown the accuracy of endoscopic
ultrasound in detecting local invasion. Therefore, pre-operative
staging of esophageal cancer should include both PET and endoscopic
ultrasound. In addition, PET is advocated as the most accurate imaging
study to detect recurrent disease, and to follow patients who have
undergone chemotherapy and radiation therapy (Radiographics
2000;20:713-723).
Esophageal cancer, including squamous
and adenocarcinoma, is one of many oncological indications approved
for reimbursement by Medicare/Medicaid and most private insurance
companies.
Clinical Case
Studies
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Main
Street Radiology
PET
Clinical
Case Studies |
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