Figure 1.

Primary staging. In patients being staged for locally advanced cancer, more sensitive detection of metastatic disease by positron emission tomography/computed tomography (PET/CT) provides both avoidance of expensive and toxic therapies and a baseline for therapeutic response assessment. In this patient with locally advanced gastro-oesophageal cancer, baseline [¹⁸F]fluorodeoxyglucose (FDG) PET/CT demonstrated high uptake in normal-sized lesser curve nodes (red arrows) and therefore neoadjuvant chemoradiation was delivered. Follow-up FDG PET/CT prior to planned oesophagectomy demonstrated a poor local response to treatment and development of increased activity in the superior mediastinum in a non-enlarged node, as well as multiple small liver metastases (blue arrows) that were not apparent on CT but were confirmed by later progression.