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The purpose of the current study is to evaluate the clinical value of <18>F- fluorodeoxyglucose PET/CT on detecting post-operative recurrence in patients with esophageal cancer. Methods 37 post-operative patients with esophageal cancer underwent PET/CT scans from June 2003 through August 2005 to detect recurrent disease; a final diagnosis was reached by the histopathology or clinical follow-up of at least 6 months. The diagnostic sensitivity, specificity, and accuracy of
PET/CT were assessed at local, regional and distant sites, as well as overall estimate for a composite of all the above sites. The false-positive and false- negative results of PET/CT were analyzed as well. Results 31 out of 37 patients were finally confirmed with recurrence in a total of 46 sites. There were six false-positive findings in PET/CT reports
involving two sites at esophagogastric anastomosis, one near the back wall of gastric pull-up, two at hilar lymph nodes, and one in left lower lung. There were three false-negative PET/CT interpretations including one subcarina lymph node, one paratracheal lymph node and one metastatic lesion in the right lower lung. The overall sensitivity, specificity and
accuracy of PET/CT for detecting recurrence were 93.5％(43/46), 76.9％(20/26) and 87.5％ (63/72), respectively. On a site-based analysis, it was found that only the specificity at local sites was lower (50％) because of a high rate of false-positive
findings (3 cases in 6). In contrast, PET/CT had excellent performance both at regional and distant sites, the sensitivity, specificity and accuracy were 86.7％, 84.6％ and 85.7％ for regional recurrence, versus 95.5％, 85.7％ and 93.1％ for distant metastasis, respectively. Conclusion <18>F-FDG PET/CT is highly effective in detecting regional and distant recurrence for post-operative patients with esophageal cancer. However the specificity was rather low at local area due to a high rate of positive findings, particularly at anastomosis, endoscopy is essential to reach a final diagnosis in this instance.