The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

Misra, Subhasis; Choi, Mark; Livingstone, Alan S.; Franceschi, Dido

doi:10.1007/s00464-011-1911-y

Cited by 39 publications

(21 citation statements)

References 23 publications

(23 reference statements)

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“…EUS is a useful tool in assessing the extent of disease as well as response to chemotherapy, when the dimensions of the tumor are analyzed as the primary variable. However, EUS is unreliable for staging esophageal cancer after neoadjuvant chemoradiation [42] . Other potential limitations of EUS do exist.…”

Section: Staging Of Esophageal Cancermentioning

confidence: 99%

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Napier

Scheerer

Misra

2014

WJGO

690

604

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of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy. Key words: Esophageal cancer; Esophageal cancer staging; Esophageal squamous cell carcinoma; Esophageal adenocarcinoma; Surgery Core tip: Esophageal carcinoma is a serious malignancy with regards to mortality and prognosis, and is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide but the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the TNM system. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy. Including surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis.Napier KJ, Scheerer M, Misra S. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol 2014; 6(5): 112-120 Available from:

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Section: Staging Of Esophageal Cancermentioning

confidence: 99%

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Napier

Scheerer

Misra

2014

WJGO

690

604

View full text Add to dashboard Cite

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“…Endoscopic ultrasound (EUS) is considered the most accurate procedure for preoperative local staging of ESCC, but it is unreliable for staging after CRT largely due to the therapeutic related inflammatory effect or fibrosis [13, 14]. Moreover, EUS is relatively invasive and operator-dependent and it has two other limitations: severe stenosis blocks the passage of the endoscope, and its finite depth of penetration may be insufficient for staging T4 tumors.…”

Section: Introductionmentioning

confidence: 99%

FDG PET using SUVmax for preoperative T-staging of esophageal squamous cell carcinoma with and without neoadjuvant chemoradiotherapy

Huang

et al. 2017

BMC Med Imaging

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BackgroundAccurate T-staging is pivotal for predicting prognosis and selecting appropriate therapies for esophageal squamous cell carcinoma (ESCC). The diagnostic performance of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for its T-staging is uncertain. We investigated use of FDG PET/CT for preoperative T-staging of patients with ESCC.MethodsPatients with ESCC given preoperative FDG PET/CT scans, either with (CRT[+] group) or without (CRT[−] group) neoadjuvant chemoradiotherapy, were retrospectively reviewed. Maximal standardized uptake value (SUVmax) of the primary tumors on FDG PET/CT scans were measured, and histopathological results were used as the reference standard. The associations between pathological T-stage and potential factors of age, tumor location, tumor grade, tumor size, and tumor SUVmax were analyzed. The cut-off levels of SUVmax for predicting different T-stages and for residual viable tumors after neoadjuvant chemoradiotherapy were determined using receiver operating characteristic analyses.ResultsWe enrolled 103 patients (45 in the CRT[−] group; 58 in the CRT[+] group). SUVmax, an independent predictive factor, positively correlated with the pathological T-stage in both groups (CRT[−] group: ρ = 0.736, p < 0.001; and CRT[+] group: ρ = 0.792, p < 0.001). The overall accuracy of the PET/CT with thresholded SUVmax for predicting the pathological T-stage was 73.3% in the CRT[−] group (SUVmax of T0: 0–1.9, T1: 2.0–4.4, T2: 4.5–6.5, T3: 6.6–13.0, T4: >13.0) and 67.2% in the CRT[+] group (SUVmax of T0: 0–3.4, T1: 3.5–3.9, T2: 4.0–5.5, T3: 5.6–6.2, T4: > 6.2). For CRT[−] group, the accuracy using an SUVmax cut-off of 4.4 to differentiate early (T0-1) from locally advanced disease (T2-4) was 82.2% (95% CI, 71.1–93.4%). For CRT[+] group, the accuracy using an SUVmax cut-off of 3.4 to predict residual viable tumors (non-T0) after completion of chemoradiotherapy was 82.8% (95% CI, 73.0–92.5%).ConclusionsThe FDG avidity of a primary esophageal tumor significantly positively correlated with the pathological T-stage. PET/CT with thresholded SUVmax was useful for predicting T-stage and differentiating residual viable tumors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-016-0171-7) contains supplementary material, which is available to authorized users.

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“…Endoscopic ultrasound (EUS) has been shown to not accurately predict pathologic stage in patients with oesophageal cancer who have received neoadjuvant treatment. Thus it should no longer be routinely performed for restaging purposes [15,16]. The most commonly used imaging investigations to reassess patients for resection after neoadjuvant treatment include computed tomography (CT) and positron emission with fluoro-2-deoxyglucose (FDG-PET) preferably performed in a hybrid fashion as PET/CT [2,13,14,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer

et al. 2013

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OBJECTIVES: To assess the diagnostic accuracy of 64-multidetector CT (MDCT) for restaging of patients with oesophageal cancer undergoing neoadjuvant therapy. METHODS: Results of pathological staging were correlated with those from 64-MDCT before and after neoadjuvant treatment in 35 patients using the American Joint Committee on Cancer/TNM classification (7th edition). CT response was determined using the Response Evaluation Criteria in Solid Tumours (RECIST) method, modified for one-dimensional tumour diameter measurement. RESULTS: 64-MDCT predicted T stage correctly in 34 % (12/35), overstaged in 49 % (17/35) and understaged in 17 % (6/35). Sensitivity/specificity values were as follows: T0, 20 %/92 %; T1-T2, 31 %/59 %; T3, 60 %/64 %; T4, 100 %/4 %. Negative predictive values for T3/T4 were 80 %/100 %. MDCT accurately predicted complete histopathological response in 20 % (accuracy 74 %) and overstaged in 80 %. Tumour regression grade was predicted correctly in only 8 % (2/25) and underestimated in 68 % (17/25). Accurate N stage was noted in 69 % (24/35). CONCLUSION: Although MDCT tends to be able to exclude advanced tumour stages (T3, T4) with a higher likelihood, the diagnostic accuracy of high resolution MDCT for restaging oesophageal cancer and assessing the response to neoadjuvant therapy has not improved in comparison to older-generation CT. Therefore, the future assessment of oesophageal tumour response should focus on combined morphologic and metabolic imaging. KEY POINTS: • Multidetector CT (MDCT) has been beneficial for the evaluation of many tumours.• However diagnostic accuracy for restaging oesophageal cancer has not improved with MDCT.• MDCT tends to be able to exclude advanced tumour stages (T3/T4).• MDCT has a low accuracy for determining lymph node metastasis.• Oesophageal tumour response should be assessed by combined morphological and metabolic imaging. Conclusion Although MDCT tends to be able to exclude advanced tumour stages (T3, T4) with a higher likelihood, the diagnostic accuracy of high resolution MDCT for restaging oesophageal cancer and assessing the response to neoadjuvant therapy has not improved in comparison to older-generation CT. Therefore, the future assessment of oesophageal tumour response should focus on combined morphologic and metabolic imaging. Key Points • Multidetector CT (MDCT) has been beneficial for the evaluation of many tumours.• However diagnostic accuracy for restaging oesophageal cancer has not improved with MDCT.• MDCT tends to be able to exclude advanced tumour stages (T3/T4).• MDCT has a low accuracy for determining lymph node metastasis.• Oesophageal tumour response should be assessed by combined morphological and metabolic imaging.

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The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

Cited by 39 publications

References 23 publications

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

FDG PET using SUVmax for preoperative T-staging of esophageal squamous cell carcinoma with and without neoadjuvant chemoradiotherapy

Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer

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