Surgically resected T1‐ and T2‐stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

Abstract

This study aimed to evaluate the frequency of nodal metastases and to disclose the diagnostic performance of endoscopic ultrasonography (EUS) and PET/CT in T and N staging in surgically resected early‐stage esophageal squamous cell carcinomas (eSCCs). Institutional review board approved this retrospective study with waiver of informed consent for reviewing medical record. We included 435 patients with an early T‐stage (Tis or T1a [≤T1a], T1b and T2) eSCC. The rates of metastatic lymphadenopathy were calculated. Then, the performance of EUS and PET/CT in subdividing T and N stages was assessed. 131 ≤ T1a, 234 T1b, and 70 T2 eSCCs were identified. In discriminating ≤T1a from other cancers, the sensitivity, specificity, and accuracy of EUS were 60.3% (79/131), 80.3% (244/304), and 74.3% (323/435) respectively. With ROC curve analysis, cut‐off value of SUVmax 3.05 at PET provided sensitivity 74.8% (98/131), specificity 70.1% (213/304), and accuracy 71.5% (311/435) for differentiating ≤T1a eSCCs from others. Ten (7.6%) of 131 ≤ T1a cancers had nodal metastasis. In discriminating N0 from node‐positive disease, sensitivity, specificity, and accuracy of EUS were 89.6% (267/298), 41.6% (57/137), and 74.5% (324/435), respectively, whereas those of PET/CT were 88.9% (265/298), 38.7% (53/137), and 73.1% (318/435) respectively. In >70% of patients with ≤T1a eSCCs, the tumor stage can be discriminated from higher stage cancers by using EUS or PET/CT. Substantial percentage (7.6%) of ≤T1a eSCC patients have nodal metastases, which are missed in more than half of the patients in clinical staging.

The role of primary tumor SUVmax in the diagnosis of invasion depth: a step toward clinical T2N0 esophageal cancer

“…The of cT1a, cT1b, cT2, and cT3 staged by EUS was 56%, 58%, 10%, and 70%, respectively (29). Apart from EUS, CT, which relies on wall thickness, cannot provide adequate information (30)(31)(32). Therefore, further study in this field would be on shaky ground as long as this problem remains unsolved.…”

Improved detection of metastatic lymph nodes in oesophageal squamous cell carcinoma by combined interpretation of fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography

“…Hsu, et al reported that although positive nodal FDG uptake on PET/CT was related to the pathologic findings of regional lymph node, the ability of PET/CT to predict lymph node metastasis remained inadequate [28]. Jeong, et al also found PET/CT missed nodal metastasis detection in more than half of the patients with early stage oesophageal SCC [29]. A recent meta-analysis study indicated the 18 F-FDG PET/CT for detecting regional lymph node metastasis had a sensitivity and specificity with 95% CI of 62% (40–79) and 96% (93–98) [30].…”

Użyteczność i ograniczenia badania 18F-FDG PET/CT w diagnostyce nowotworu złośliwego przełyku

“…Rzadko występującą postacią histologiczną OC jest rak gruczołowy (ang. oesophageal adenocarcinoma -OAC), którego częstość występowania istotnie wzrosła w minionych latach, szczególnie w krajach Europy Północnej i Zachodniej, [8][9][10]. Najwyższy odsetek nowych zachorowań na świecie, zanotowano w Zjednoczonym Królestwie w roku 2012 (OAC) oraz w Azji Środkowej (OSCC) [10].…”

“…Czułość i swoistość metody 18 F-FDG PET/CT w ocenie przerzutów odległych w przebiegu OSCC wynosi odpowiednio 81%, 91% [11]. Zdaniem autorów [2,9,[11][12][13][14], może być ponadto wykorzystywana w ocenie cechy N, szczególnie u chorych z rozpoznanym OAC (Tabela 1.). Ograniczeniem badania 18 F-FDG PET/CT w diagnostyce przerzutów do węzłów chłonnych jest jednakże niska -w stosunku do wymiarów węzłów chłonnych -rozdzielczość przestrzenna.…”

“…Czułość, specyficzność i dokładność diagnostyczna metody 18 F-FDG PET/CT w ocenie zaawansowania węzłowego OSCC i OAC (źródło:[9,14])…”