# Alleged Misinterpretation of PET-CT in Esophageal Carcinoma Staging: A Medico-Legal Case Report

## TL;DR

A case report discusses how a PET-CT scan misinterpreted a metastatic lymph node as a pancreatic tumor, leading to a legal dispute over diagnostic delays in esophageal cancer.

## Contribution

This case emphasizes the limitations of PET-CT specificity and the necessity of tissue confirmation in oncologic staging.

## Key findings

- PET/CT identified a hypermetabolic lesion in the pancreas, later confirmed as a metastatic lymph node.
- The case was reviewed legally and medically, affirming adherence to the standard of care despite diagnostic uncertainty.
- The patient's outcome was attributed to the aggressive nature of stage IV cancer rather than diagnostic delay.

## Abstract

Diagnostic imaging is pivotal in the staging of esophageal carcinoma, yet interpretation of metabolic findings can be challenging because positron emission tomography/computed tomography (PET/CT) is highly sensitive but may lack specificity, sometimes limiting differentiation between primary and metastatic lesions without histopathological correlation. We report a medico-legal case involving an alleged misdiagnosis in which a metastatic lymph node was perceived as a synchronous pancreatic malignancy, purportedly delaying treatment. A 65-year-old female presented with upper abdominal discomfort and was diagnosed with esophageal squamous cell carcinoma via endoscopy. Subsequent staging with 18F-FDG PET/CT revealed a hypermetabolic lesion in the pancreatic body, characterized as neoplastic, with a recommendation for clinical correlation. The patient interpreted this finding as a second primary cancer (pancreatic), resulting in significant distress. An endoscopic ultrasound-guided biopsy subsequently confirmed that the lesion represented a metastatic lymph node of esophageal origin. The patient underwent palliative chemotherapy but died from disease progression 14 months after diagnosis. A legal claim alleged that the diagnostic investigation of the presumed "pancreatic mass" delayed life-saving treatment. This case highlights the limitations of PET/CT specificity and the critical role of tissue diagnosis in oncologic staging; medico-legal analysis indicated that the imaging report met the standard of care by identifying the abnormality and recommending biopsy. Expert review concluded that the timeline of care was appropriate for complex staging and that the outcome was driven by the aggressive biology of stage IV esophageal cancer rather than diagnostic delay, underscoring the need to manage patient expectations regarding imaging uncertainty and reaffirming that adherence to diagnostic algorithms, including confirmatory biopsy, constitutes the standard of care even when it may be perceived as causing delays.