Impact of PET-CT scan on management in upper gastrointestinal malignancy

Curative treatments of upper gastrointestinal (UGI) cancers carry significant morbidity and mortality. Therefore, accurate pre-treatment staging is important. PET-CT scan is an expensive modality, and not readily available in New Zealand. The aim of this study was to describe how PET-CT scan influences management in UGI cancer.

This retrospective descriptive study included patients with UGI cancer with no evidence of metastatic disease on IV contrast CT scan, and those medically fit for curative treatment. Patients then underwent PET-CT scan. We defined influence or change in management if PET-CT showed metastatic disease or other lesions requiring further investigation.

Seventy-nine patients were identified for the purposes of this study. Fifty-nine (74.7%) had CT scan showing no evidence of metastatic disease. Of these, PET-CT scan influenced management in 14 patients (23.7%) and found distant metastasis in eight patients (13.6%). The remaining 20 of 79 patients (25.3%) had CT scan showing indeterminate lesions. Of these, PET-CT scan influenced management in eight patients (40%), with metastatic disease seen in seven patients (35%).

Our study confirms the value of PET-CT scan in pre-operative staging of UGI cancer. It had a greater impact on patients with intermediate lesions on staging CT.