The New Era of Staging as a Key for an Appropriate Treatment for Esophageal Cancer

Abstract

Fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) have become the gold standard for staging of esophageal cancer by detecting distant metastases, but metastatic lymph nodes are often difficult to diagnose from the size and standardized uptake value (SUV). If we compare the diagnostic performance of endoscopic ultrasonography (EUS), CT, and FDG-PET in staging of esophageal cancer, EUS is the most sensitive method to identify the detection of regional lymph node metastases, whereas CT and FDG-PET are more specific tests. Combination study with CT, EUS and PETCT cannot make a precise diagnosis after neoadjuvant therapy (NAT). A precise staging might be determined by the fine needle aspiration biopsy (FNAB) under EUS and US screening in the neck and the abdomen even after NAT. Indication of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for superficial cancer is sensitive because of difficulty in T1b cancer diagnosis. Detailed examination about vessel invasion and the possibility of residual tumor with dissected specimen will offer an appropriate additional therapy. New strategy like sentinel lymph node (SLN) navigation could supply more information about lymphatic routes and metastatic nodes. SLN navigation with ESD might become a new less invasive strategy for superficial esophageal cancer.

Talen-mediated girdin knockout downregulates cell proliferation, migration and invasion in human esophageal carcinoma ECA109 cells

“…A previous study also investigated the correlation between girdin expression and clinical data using specimens resected from ESCC patients, and its immunohistochemical (IHC) data demonstrated a similar result, in that the overall survival was notably longer in samples with lower girdin expression compared with that in samples with a higher girdin expression (12). Esophageal cancer commonly occurs with highly invasive and metastatic characteristics (15,16) and due to the evidence demonstrating that girdin is involved in the regulation of cell motility (17,18), it was further investigated whether girdin had a role in the migratory behavior in ESSC ECA109 cells. The present study identified that talen-mediated girdin KO significantly inhibited cell migration in ECA109 cells, which is consistent with the findings from a study by Shibata et al (12), where cell migration was significantly reduced in ESCC KYSE cells transfected with girdin-specific small interfering RNA.…”

Concordance of studies for nodal staging is prognostic for worse survival in esophageal cancer

“…Our findings suggest that N+ disease by more than one modality may confer a worse prognosis than patients with N+ disease by only one modality. While studies have looked to determine differences in sensitivity, specificity, and accuracy of each modality, perhaps CT, PET, and EUS evaluate separate characteristics of lymph nodes that work in synergy to differentiate N+ from N− . Although we did not find a statistically significant difference among the different combinations of positive studies, again, the number of patients in this study may limit the ability to detect subtle differences.…”

“…Because nodal status is a key determinant of treatment and prognosis, understanding the best combination and sequence of studies for accurate clinical staging is critical for these patients. While all three modalities are widely used, there is a lack of consensus regarding their use alone, in combination, or in sequence . Several studies have attempted to define the sensitivity, specificity, and accuracy of these tests, but no studies have evaluated the prognostic significance of concordance of two or more modalities …”

Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis for thoracic esophageal squamous cell carcinoma

“…However, diagnosing lymph node metastasis is often difficult from its size and maximum standardized uptake value (SUVmax)[1]. The predictive value of PET/CT in primary staging in patients with esophageal carcinoma is under discussion.…”