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Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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2
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Suzuki L, ten Kate FJC, Gotink AW, Stoop H, Doukas M, Nieboer D, Spaander MCW, van Lanschot JJB, van Wijnhoven BPL, Koch AD, Bruno MJ, Looijenga LHJ, Biermann K. Olfactomedin 4 (OLFM4) expression is associated with nodal metastases in esophageal adenocarcinoma. PLoS One 2019; 14:e0219494. [PMID: 31283789 PMCID: PMC6613772 DOI: 10.1371/journal.pone.0219494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
To date no informative biomarkers exist to accurately predict presence of lymph node metastases (LNM) in esophageal adenocarcinoma (EAC). We studied the discriminative value of Olfactomedin 4 (OLFM4), an intestinal stem cell marker, in EAC. Patients who had undergone esophagectomy as single treatment modality for both advanced (pT2-4) and early (pT1b) adenocarcinoma of the esophagus or gastro-esophageal junction were selected for this study from an institutional database (Erasmus MC University Medical Center, Rotterdam, The Netherlands). Surgical resection specimens of 196 advanced and 44 early EAC were examined. OLFM4 expression was studied by immunohistochemistry and categorized as low (<30%) or high (> = 30%) expression. Low OLFM4 was associated with poor differentiation grade in both advanced (60% vs. 34.8%, p = 0.001) and early EAC (39.1% vs. 9.5%, p = 0.023). LNM were present in 161 (82.1%) of advanced and 9 (20.5%) of early EAC respectively. Low OLFM4 was independently associated with the presence of LNM in advanced EAC in multivariable analysis (OR 2.7; 95% CI, 1.16-6.41; p = 0.022), but not in early EAC (OR 2.1; 95% CI, 0.46-9.84; p = 0.338). However, the difference in association with LNM between advanced (OR 2.7; 95% CI, 1.18-6.34; p = 0.019) and early (OR 2.3; 95% CI, 0.47-11.13; p = 0.302) EAC was non-significant (p = 0.844), suggesting that the lack of significance in early EAC is due to the small number of patients in this group. OLFM4 was not of significance for the disease free and overall survival. Overall, low expression of intestinal stem cell marker OLFM4 was associated with the presence of LNM. Our study suggests that OLFM4 could be an informative marker with the potential to improve preoperative assessment in patients with EAC. Further studies are needed to confirm the value of OLFM4 as a biomarker for LNM.
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Affiliation(s)
- Lucia Suzuki
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Fiebo J. C. ten Kate
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Annieke W. Gotink
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Hans Stoop
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Jan J. B. van Lanschot
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Bas P. L. van Wijnhoven
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Arjun D. Koch
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Leendert H. J. Looijenga
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Cancer Institute, Rotterdam, The Netherlands
- * E-mail:
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3
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Zhu S, Wei Y, Gao F, Li L, Liu Y, Huang Z, Tang H, Zheng D, Wei X, Sun T, Song B. Esophageal carcinoma: Intravoxel incoherent motion diffusion-weighted MRI parameters and histopathological correlations. J Magn Reson Imaging 2019; 49:253-261. [PMID: 29734492 DOI: 10.1002/jmri.26172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The pathological grade of esophageal carcinoma is highly determinant of patient prognosis, but it still cannot be adequately evaluated preoperatively. Compared with conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM) diffusion-weighted MRI can separate true molecular diffusion and perfusion in tissues and has been shown to be useful in characterizing malignant tumors. There is no report that compared IVIM and conventional DWI in grading esophageal carcinoma. PURPOSE To prospectively determine the diagnostic performance of conventional DWI and IVIM models in differentiating the pathological differentiated grade of esophageal carcinoma. STUDY TYPE Prospective. POPULATION A cohort comprising 81 patients with newly diagnosed esophageal squamous cell carcinoma (ESCC) between December 2015 and August 2017 were evaluated. FIELD STRENGTH/SEQUENCE 3.0T, axial echo-planer imaging, fast spin echo (FSE) sequence, IVIM sequence (b = 0, 20, 50, 80, 100, 150, 200, 400, 600, 800, 1000, 1200). ASSESSMENT Apparent diffusion coefficient (ADC), true ADC (ADCslow ), pseudo ADC (ADCfast ), and perfusion fraction (f) of each tumor were calculated by two independent radiologists. Histopathologic grade was used as the reference standard. STATISTICAL TESTS Games-Howell test; diagnostic accuracy; Spearman correlation; intraclass correlation coefficient; and Bland-Altman analysis. Receiver operating characteristics (ROC) curves. RESULTS ADCslow demonstrated the highest area under curve (AUC) with a value of 0.830 (95% confidence interval [CI]: 0.730-0.904) and 0.816 (95% CI: 0.714-0.893) by two radiologists, followed by ADC with a value of 0.754 (95% CI: 0.646-0.843) and 0.761 (95% CI: 0.653-0.848). Good correlation was obtained between the histologic grade and ADCslow (r(R1) = 0.748, r(R2) = 0.720) and ADC (r(R1) = 0.576, r(R2) = 0.571). DATA CONCLUSION ADCslow and ADC had a significantly higher performance than the ADCfast and f, and ADCslow had a significantly higher performance than the ADC. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:253-261.
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Affiliation(s)
- Shaocheng Zhu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Feifei Gao
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Linlin Li
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuehua Liu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Tingyi Sun
- Department of Pathology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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4
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Cox BF, Stewart F, Lay H, Cummins G, Newton IP, Desmulliez MPY, Steele RJC, Näthke I, Cochran S. Ultrasound capsule endoscopy: sounding out the future. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:201. [PMID: 28567381 DOI: 10.21037/atm.2017.04.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Video capsule endoscopy (VCE) has been of immense benefit in the diagnosis and management of gastrointestinal (GI) disorders since its introduction in 2001. However, it suffers from a number of well recognized deficiencies. Amongst these is the limited capability of white light imaging, which is restricted to analysis of the mucosal surface. Current capsule endoscopes are dependent on visual manifestation of disease and limited in regards to transmural imaging and detection of deeper pathology. Ultrasound capsule endoscopy (USCE) has the potential to overcome surface only imaging and provide transmural scans of the GI tract. The integration of high frequency microultrasound (µUS) into capsule endoscopy would allow high resolution transmural images and provide a means of both qualitative and quantitative assessment of the bowel wall. Quantitative ultrasound (QUS) can provide data in an objective and measurable manner, potentially reducing lengthy interpretation times by incorporation into an automated diagnostic process. The research described here is focused on the development of USCE and other complementary diagnostic and therapeutic modalities. Presently investigations have entered a preclinical phase with laboratory investigations running concurrently.
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Affiliation(s)
- Benjamin F Cox
- School of Medicine, University of Dundee, Dundee DD1 5EH, Scotland, UK
| | - Fraser Stewart
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK
| | - Holly Lay
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
| | - Gerard Cummins
- School of Engineering & Physical Sciences, Heriot-Watt University, Scotland EH14 4AS, UK
| | - Ian P Newton
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK
| | - Marc P Y Desmulliez
- School of Engineering & Physical Sciences, Heriot-Watt University, Scotland EH14 4AS, UK
| | - Robert J C Steele
- School of Medicine, University of Dundee, Dundee DD1 5EH, Scotland, UK
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK
| | - Sandy Cochran
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
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5
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Old OJ, Isabelle M, Barr H. Staging Early Esophageal Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 908:161-81. [PMID: 27573772 DOI: 10.1007/978-3-319-41388-4_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Staging esophageal cancer provides a standardized measure of the extent of disease that can be used to inform decisions about therapy and guide prognosis. For esophageal cancer, the treatment pathways vary greatly depending on stage of disease, and accurate staging is therefore crucial in ensuring the optimal therapy for each patient. For early esophageal cancer (T1 lesions), endoscopic resection can be curative and simultaneously gives accurate staging of depth of invasion. For tumors invading the submucosa or more advanced disease, comprehensive investigation is required to accurately stage the tumor and assess suitability for curative resection. A combined imaging approach of computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) offers complementary diagnostic information and gives the greatest chance of accurate staging. Staging laparoscopy can identify peritoneal disease and small superficial liver lesions that could be missed on CT or PET, and alters management in up to 20 % of patients. Optical diagnostic techniques offer the prospect of further extending the possibilities of endoscopic staging in real time. Optical coherence tomography can image superficial lesions and could provide information on depth of invasion for these lesions. Real-time lymph node analysis using optical diagnostics such as Raman spectroscopy could be used to support immediate endoscopic therapy without waiting for results of cytology or further investigations.
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Affiliation(s)
- O J Old
- Upper GI Surgery Department, Gloucestershire Royal Hospital, Gloucester, UK. .,Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucester, UK.
| | - M Isabelle
- Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucester, UK
| | - H Barr
- Upper GI Surgery Department, Gloucestershire Royal Hospital, Gloucester, UK
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6
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Triadafilopoulos G, Akiyama J. Emerging endoscopic techniques for the identification of esophageal disease. Expert Rev Gastroenterol Hepatol 2017; 10:605-13. [PMID: 26753504 DOI: 10.1586/17474124.2016.1140037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Esophageal diseases, both benign and malignant, impose an increasing burden to global health. In the West, gastroesophageal reflux disease (GERD) and Barrett's esophagus are increasing in prevalence and impact. In the East, squamous esophageal cancer remains a large burden, but increasingly, precancerous lesions related to GERD are recognized. We review the various advanced endoscopic techniques that have been developed to improve the accuracy of endoscopic identification of esophageal disease. These techniques are designed to increase the sensitivity of detecting disease and high-risk lesions, enable targeted biopsies, decrease total number of biopsies and costs for surveillance, but also guide therapy in real-time. After proper clinical validation, the widespread use of these technologies will lead to improved outcomes, mostly in cancer prevention.
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Affiliation(s)
- George Triadafilopoulos
- a School of Medicine, Division of Gastroenterology & Hepatology , Stanford University , Stanford , CA , USA
| | - Junichi Akiyama
- b Division of Gastroenterology , National Center for Global Health and Medicine , Tokyo , Japan
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7
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Wei Y, Wu S, Shi D, Dou S, Sun T, Ning P, Zhao C, Li Z, Li X, Gao F, Li L, Zheng D, Zhu S. Oesophageal carcinoma: comparison of ex vivo high-resolution 3.0 T MR imaging with histopathological findings. Sci Rep 2016; 6:35109. [PMID: 27725771 PMCID: PMC5057120 DOI: 10.1038/srep35109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/26/2016] [Indexed: 01/03/2023] Open
Abstract
High-resolution magnetic resonance (MR) images clearly depict the normal oesophageal wall as consisting of eight layers, which correlates well with histopathological findings. In 56 (91.8%) of 61 lesions, the depth of oesophageal wall invasion determined through MR imaging was consistent with histopathological staging (r = 0.975, P < 0.001). The sensitivity, specificity and accuracy for the mucosa were 71.4%, 98.1%, and 95.1%, respectively, and the corresponding values for the submucosa were 82.4%, 95.5%, and 91.8%; for the muscularis propria, the sensitivity, specificity and accuracy were 100%, 95.7%, and 96.7%, respectively, and for the adventitia, these values were 100%, 100%, and 100%. The Cohen k values for interobserver agreement were excellent: K = 0.839, P < 0.001 (observer 1 vs. observer 2); K = 0.908, P < 0.001 (observer 1 vs. observer 3); and K = 0.885, P < 0.01 (observer 2 vs. observer 3). High-resolution ex vivo MR images obtained with a 3.0 T scanner can be used to precisely evaluate oesophageal carcinoma invasion and provide good diagnostic sensitivity, specificity and accuracy.
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Affiliation(s)
- Yi Wei
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Sen Wu
- Center of Thoracic Tumor, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Center of Thoracic Tumor, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Dapeng Shi
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Shewei Dou
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Tingyi Sun
- Department of Pathology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Peigang Ning
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Cuihua Zhao
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Ziyuan Li
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Xiaodong Li
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Feifei Gao
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Linlin Li
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | | | - Shaocheng Zhu
- Department of Radiology, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
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8
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Wei Y, Wu S, Gao F, Sun T, Zheng D, Ning P, Zhao C, Li Z, Li X, Li L, Zhu S. Esophageal carcinoma: Ex vivo evaluation by high-spatial-resolution T 2 -mapping MRI compared with histopathological findings at 3.0T. J Magn Reson Imaging 2016; 45:1609-1616. [PMID: 27711986 DOI: 10.1002/jmri.25509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/23/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To prospectively determine the feasibility of T2 -mapping magnetic resonance imaging (MRI) to quantitatively describe the signal characteristics of the normal esophageal wall and assess the depth of esophageal wall invasion by carcinoma at 3.0T. MATERIALS AND METHODS Thirty-two patient specimens, each having foci of carcinoma, were studied using 3.0T MR. Freehand regions of interest were placed to measure the T2 value of the normal esophageal layers and were compared with the regions of carcinoma. Three independent readers reviewed the MR images to evaluate the depth of carcinoma invasion; when the three radiologists could not fully agree with each other, the final stage was determined by consensus. The Games-Howell test was used to compare the difference between the normal esophageal layers and carcinoma. Spearman correlation coefficient analysis was used to compare the stage at MRI with that at histopathological analysis. The interobserver agreement was compared with Cohen's kappa. The sensitivity, specificity, and accuracy for detecting carcinoma invasion were calculated. RESULTS The T2 values between the carcinoma and normal esophageal layers were different (all P < 0.01), except for the inner circular muscle (P = 0.511). The T2 value of each layer of the normal esophageal wall was also different from that of the adjacent layer (all P < 0.01). In 29 of 32 lesions, the depth of the esophageal wall invasion determined by MR was consistent with the histopathological stage (r = 0.969, P < 0.001). The sensitivity, specificity, and accuracy were 80%, 96.3%, and 93.8%, respectively, for invasion into the mucosa; 77.8%, 95.7%, and 90.6%, respectively, for invasion into submucosa; 100%, 95.8%, and 96.9%, respectively, for invasion into muscularis propria; and 100%, 100%, and 100%, respectively, for invasion into the adventitia. CONCLUSION T2 -mapping MR images obtained using a 3.0T MR scanner can be used to depict the precise histopathological layers of the esophageal wall clearly and provide excellent diagnostic accuracy for assessing esophageal carcinoma invasion. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1609-1616.
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Affiliation(s)
- Yi Wei
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Sen Wu
- Center of Thoracic Tumor, Henan Provincial People's Hospital, Zhengzhou, China
| | - Feifei Gao
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tingyi Sun
- Department of Pathology, Henan Provincial People's Hospital, Zhengzhou, China
| | | | - Peigang Ning
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Cuihua Zhao
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ziyuan Li
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaodong Li
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Linlin Li
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shaocheng Zhu
- Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
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9
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Valmasoni M, Pierobon ES, Ruol A, De Pasqual CA, Zanchettin G, Moletta L, Salvador R, Costantini M, Merigliano S. Endoscopic Tumor Length Should Be Reincluded in the Esophageal Cancer Staging System: Analyses of 662 Consecutive Patients. PLoS One 2016; 11:e0153068. [PMID: 27088503 PMCID: PMC4835067 DOI: 10.1371/journal.pone.0153068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/23/2016] [Indexed: 12/23/2022] Open
Abstract
Esophageal cancer represents the 6th cause of cancer mortality in the World. New treatments led to outcome improvements, but patient selection and prognostic stratification is a critical aspect to gain maximum benefit from therapies. Today, patients are stratified into 9 prognostic groups, according to a staging system developed by the American Joint Committee on Cancer. Recently, trying to better select patients with curing possibilities several authors are reconsidering tumor length as a valuable prognostic parameter. Specifically, endoscopic tumor length can be easily measured with an esophageal endoscopy and, if its utility in esophageal cancer staging is demonstrated, it may represent a simple method to identify high risk patients and an easy-to-obtain variable in prognostic stratification. In this study we retrospectively analyzed 662 patients treated for esophageal cancer, stratified according to cancer histology and current staging system, to assess the possible role of endoscopic tumor length. We found a significant correlation between endoscopic tumor length, current staging parameters and 5-year survival, proving that endoscopic tumor length may be used as a simple risk stratification tool. Our results suggest a possible indication for preoperative therapy in early stage squamocellular carcinoma patients without lymph nodes involvement, who are currently treated with surgery alone.
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Affiliation(s)
- Michele Valmasoni
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Elisa Sefora Pierobon
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Alberto Ruol
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Carlo Alberto De Pasqual
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Gianpietro Zanchettin
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Lucia Moletta
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Renato Salvador
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Mario Costantini
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Stefano Merigliano
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
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Karmazanovsky GG, Buryakina SA, Kondratiev EV, Yang Q, Ruchkin DV, Kalinin DV. Value of two-phase dynamic multidetector computed tomography in differential diagnosis of post-inflammatory strictures from esophageal cancer. World J Gastroenterol 2015; 21:8878-8887. [PMID: 26269677 PMCID: PMC4528030 DOI: 10.3748/wjg.v21.i29.8878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize the computed tomography (CT) findings in patients with post-inflammatory esophageal strictures (corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing post-inflammatory esophageal stricture and esophageal cancer.
METHODS: Sixty-five patients with esophageal strictures of different etiology were included in this study: 24 patients with 27 histopathologically confirmed corrosive strictures, 10 patients with 12 peptic strictures and 31 patients with esophageal cancer were evaluated with a two-phase dynamic contrast-enhanced MDCT. Arterial and venous phases at 10 and 35 s after the attenuation of 200 HU were obtained at the descending aorta, with a delayed phase at 6-8 min after the start of injection of contrast media. For qualitative analysis, CT scans of benign strictures were reviewed for the presence/absence of the following features: “target sign”, luminal mass, homogeneity of contrast medium uptake, concentric wall thickening, conically shaped suprastenotic dilatation, smooth boundaries of stenosis and smooth mucous membrane at the transition to stenosis, which were compared with a control group of 31 patients who had esophageal cancer. The quantitative analysis included densitometric parameter acquisition using regions-of-interest measurement of the zone of stenosis and normal esophageal wall and the difference between those measurements (ΔCT) at all phases of bolus contrast enhancement. Esophageal wall thickening, length of esophageal wall thickening and size of the regional lymph nodes were also evaluated.
RESULTS: The presence of a concentric esophageal wall, conically shaped suprastenotic dilatation, smooth upper and lower boundaries, “target sign” and smooth mucous membrane at the transition to stenosis were suggestive of a benign cause, with sensitivities of 92.31%, 87.17%, 94.87%, 76.92% and 82.05%, respectively, and specificities of 70.96%, 89.66%, 80.65%, 96.77% and 93.55%, respectively. The features that were most suggestive of a malignant cause were eccentric esophageal wall thickening, tuberous upper and lower boundaries of stenosis, absence of mucous membrane visualization, rupture of the mucous membrane at the upper boundary of stenosis, cup-shaped suprastenotic dilatation, luminal mass and enlarged regional lymph nodes with specificities of 92.31% 94.87%, 67.86%, 100%, 97.44%, 94.87% and 82.86%, respectively and sensitivities of 70.97%, 80.65%, 96.77%, 80.65%, 54.84%, 87.10% and 60%, respectively. The highest tumor attenuation occurred in the arterial phase (mean attenuation 74.13 ± 17.42 HU), and the mean attenuation difference between the tumor and the normal esophageal wall (mean ΔCT) in the arterial phase was 23.86 ± 19.31 HU. Here, 11.5 HU of ΔCT in the arterial phase was the cut-off value used to differentiate esophageal cancer from post-inflammatory stricture (P = 0.000). The highest attenuation of post-inflammatory strictures occurred in the delayed phase (mean attenuation 71.66 ± 14.28 HU), and the mean ΔCT in delayed phase was 34.03 ± 15.94 HU. Here, 18.5 HU of ΔCT in delayed phase was the cut-off value used to differentiate post-inflammatory stricture from esophageal cancer (P < 0.0001).
CONCLUSION: The described imaging findings reveal high diagnostic significance in the differentiation of benign strictures from esophageal cancer.
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