Positron Emission Tomography and Computed tomography (PET/CT) scanning, the method du jour for identifying and staging cancers such as esophageal cancer, has been shown to have superior accuracy when compared to mere PET and CT performed separately. However, in circumstances where PET scanning yields disparate results from CT, clinicians can be at an impasse as to how to evaluate disease progression. To prevent this, doctors of the University of North Carolina at Chapel Hill have reported the first use of PET guided biopsy that has detected stage IV esophageal cancer without obvious distant metastasis elsewhere.
In their findings, detailed in this article submitted to the Journal of Surgical Radiology on July 26, 2010, PET guided biopsy allowed correct identification of stage IV disease in a 54-year-old white female, which eluded CT scanning. After an esophagogastroduodenoscopy revealed an ulcerating lesion in the distal esophagus and a CT scan that found a marked thickening of the distal esophagus, a full PET/CT scan showed an increased FDG uptake in the left iliac bone with possible metastasis, but without correlating evidence from a CT scan. In light of this evidence, a PET guided biopsy was performed, yielding conclusive evidence of metastasis.
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