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Nobel T, Sihag S. Advances in Diagnostic, Staging, and Restaging Evaluation of Esophageal and Gastric Cancer. Surg Oncol Clin N Am 2024; 33:467-485. [PMID: 38789190 DOI: 10.1016/j.soc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The initial endoscopic and staging evaluation of esophagogastric cancers must be accurate and comprehensive in order to select the optimal therapeutic plan for the patient. Esophageal and gastric cancers (and treatment paradigms) are delineated by their proximity to the cardia (within 2 cm). The most frequent and important symptom that informs the initial staging evaluation is dysphagia, which is associated with at least cT3 or locally advanced disease. Endoscopic ultrasound is often needed if earlier stage disease is suspected, preferably in combination with endoscopic mucosal or submucosal resection or fine-needle aspiration of suspicious lymph nodes to enhance staging accuracy.
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Affiliation(s)
- Tamar Nobel
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-881, New York, NY 10065, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-881, New York, NY 10065, USA.
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2
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Nguyen CL, Tovmassian D, Isaacs A, Falk GL. Risk of lymph node metastasis in T1 esophageal adenocarcinoma: a meta-analysis. Dis Esophagus 2024; 37:doae012. [PMID: 38391209 DOI: 10.1093/dote/doae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/29/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
Patients with early (T1) esophageal adenocarcinoma (EAC) are increasingly having definitive local therapy endoscopically. Endoscopic resection is not able to pathologically stage or treat lymph node metastasis (LNM). Accurate identification of patients having nodal metastasis is critical to select endoscopic therapy over surgery. This study aimed to define the risk of LNM in T1 EAC. A meta-analysis of studies of patients who underwent surgery and lymphadenectomy with assessment of LNM was performed according to PRISMA. Main outcome was probability of LNM in T1a and T1b disease. Secondary outcomes were risk factors for LNM and rate of LNM in submucosal T1b (SM1, SM2, and SM3) disease. Registered with PROSPERO (CRD42022341794). Twenty cohort studies involving 2264 patients with T1 EAC met inclusion criteria: T1a (857 patients) with 36 (4.2%) node positive and T1b (1407 patients) with 327 (23.2%) node positive. Subgroup analysis of T1b lesions was available in 10 studies (405 patients). Node positivity for SM1, SM2, and SM3 was 16.3%, 16.2%, and 29.4%, respectively. T1 substage (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.45-13.38, P < 0.01), tumor differentiation (OR 2.82, 95% CI 2.06-3.87, P < 0.01), and lymphovascular invasion (OR 13.65, 95% CI 6.06-30.73, P < 0.01) were associated with LNM. T1a disease demonstrated a 4.2% nodal metastasis rate and T1b disease a rate of 23.2%. Endoscopic therapy should be reserved for T1a disease and perhaps select T1b disease, which has a moderately high rate of nodal metastasis. There were inadequate data to stratify T1b SM disease into 'low-risk' and 'high-risk' based on tumor differentiation and lymphovascular invasion.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - David Tovmassian
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Anna Isaacs
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
- Sydney Heartburn Clinic, Lindfield, NSW, Australia
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3
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Khandelwal Y, Singh Parihar A, Sistani G, Ramirez-Fort MK, Zukotynski K, Subramaniam RM. Role of PET/Computed Tomography in Gastric and Colorectal Malignancies. PET Clin 2024; 19:177-186. [PMID: 38199915 DOI: 10.1016/j.cpet.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This article focuses on the role of PET/computed tomography in evaluating and managing gastric cancer and colorectal cancer. The authors start with describing the common aspects of imaging with 2-deoxy-2-18F-d-glucose, followed by tumor-specific discussions of gastric and colorectal malignancies. Finally, the authors provide a brief overview of non-FDG tracers including their potential clinical applications, and describe future directions in imaging these malignancies.
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Affiliation(s)
- Yogita Khandelwal
- Department of Nuclear Medicine, AIIMS Campus, Ansari Nagar East, New Delhi, Delhi 110016, India
| | - Ashwin Singh Parihar
- Mallinckodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | - Golmehr Sistani
- Medical Imaging Department, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON L4M 6M2, Canada
| | | | - Katherine Zukotynski
- Department of Medical Imaging, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery & Health Sciences, 160 Oxford Street, Darlinghurst, NSW 2010, Australia
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Li Y, Wang JX, Yibi RH. Prediction of lymph node metastasis in early esophageal cancer. World J Gastrointest Surg 2023; 15:2294-2304. [PMID: 37969711 PMCID: PMC10642458 DOI: 10.4240/wjgs.v15.i10.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Given the poor prognosis of patients with lymph node metastasis, estimating the lymph node status in patients with early esophageal cancer is crucial. Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies, but no recent studies have included a review of this subject. AIM To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma (ESCC) and early esophageal adenocarcinoma (EAC). METHODS We searched PubMed with "[early esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)]" or "[early esophageal carcinoma (Title/Abstract)] and [lymph node (Title/Abstract)]" or "[superficial esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)]." A total of 29 studies were eligible for analysis. RESULTS Preoperative imaging (size), serum markers (microRNA-218), postoperative pathology and immunohistochemical analysis (depth of invasion, tumor size, differentiation grade, lymphovascular invasion, neural invasion, expression of PIM-1 < 30%) were predictive factors for lymph node metastasis in both early ESCC and EAC. Serum markers (thymidine kinase 1 ≥ 3.38 pmol/L; cytokeratin 19 fragment antigen 21-1 > 3.30 ng/mL; stathmin-1) and postoperative pathology and immunohistochemical analysis (overexpression of cortactin, mixed-lineage leukaemia 2, and stanniocalcin-1) were predictive for lymph node metastasis in early ESCC. Transcription of CD69, myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC. A total of 6 comprehensive models for early ESCC, including logistic regression model, nomogram, and artificial neural network (ANN), were reviewed. The areas under the receiver operating characteristic curve of these models reached 0.789-0.938, and the ANN performed best. As all these models relied on postoperative pathology, further models focusing on serum markers, imaging and immunohistochemical indicators are still needed. CONCLUSION Various factors were predictive of lymph node metastasis in early esophageal cancer, and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology. Further studies focusing on serum markers, imaging and immunohistochemical indicators are still in need.
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Affiliation(s)
- Yan Li
- Department of Gastroenterology, Lhasa People’s Hospital, Lhasa 850000, Tibet Autonomous Region, China
| | - Jun-Xiong Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
- National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100000, China
| | - Ran-Hen Yibi
- Department of Gastroenterology, Lhasa People’s Hospital, Lhasa 850000, Tibet Autonomous Region, China
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Reyhani A, Gimson E, Baker C, Kelly M, Maisey N, Meenan J, Subesinghe M, Hill M, Lagergren J, Gossage J, Zeki S, Dunn J, Davies A. Multiple staging investigations may not change management in patients with high-grade dysplasia or early esophageal adenocarcinoma. Dis Esophagus 2023; 36:doad020. [PMID: 37032121 DOI: 10.1093/dote/doad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/20/2023] [Indexed: 04/11/2023]
Abstract
The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. This coincided with a transition period from esophagectomy to endoscopic mucosal resection (EMR) as the treatment of choice. Patients were staged with computed tomography (CT), endoscopic ultrasound (EUS) and 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography(PET)/CT. The aim of this study was to assess their accuracy and impact on clinical management. 297 patients with high-grade dysplasia or early adenocarcinoma were included (endoscopic therapy/EMR n = 184; esophagectomy n = 113 [of which a 'combined' group had surgery preceded by endoscopic therapy n = 23]). Staging accuracy was low (accurate staging EMR: CT 40.1%, EUS 29.6%, FDG-PET/CT 11.0%; Esophagectomy: CT 43.3%, EUS 59.7%, FDG-PET/CT 29.6%; Combined: CT 28.6%, EUS46.2%, FDG-PET/CT 30.0%). Staging inaccuracies across all groups that could have changed management by missing T2 disease were CT 12%, EUS 12% and FDG-PET/CT 1.6%. The sensitivity of all techniques for detecting nodal disease was low (CT 12.5%, EUS 12.5%, FDG-PET/CT0.0%). Overall, FDG-PET/CT and EUS changed decision-making in only 3.2% of patients with an early cancer on CT and low-risk histology. The accuracy of staging with EUS, CT and FDG-PET/CT in patients with high-grade dysplasia or early adenocarcinoma of the esophagus is low. EUS and FDG-PET/CT added relevant staging information over standard CT in very few cases, and therefore, these investigations should be used selectively. Factors predicting the need for esophagectomy are predominantly obtained from EMR histology rather than staging investigations.
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Affiliation(s)
- A Reyhani
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - E Gimson
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - C Baker
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
| | - M Kelly
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
| | - N Maisey
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
| | - J Meenan
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
| | - M Subesinghe
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - M Hill
- Department of Oncology, Maidstone & Tunbridge Wells, Maidstone and Tunbridge Wells, UK
| | - J Lagergren
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Gossage
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - S Zeki
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - J Dunn
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - A Davies
- Oesophagogastric research group, Guy's and St Thomas' Oesophago-gastric Centre, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Jiang Y, Wen B, Li C, Tian Y, Xiao Z, Xu K, Xing D, Yu Z, Huang J, Jia J, He Y. The performance of 68Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:2114-2126. [PMID: 36808001 DOI: 10.1007/s00259-023-06138-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study was designed to compare the performance of 68Ga-FAPI-04 and 18F-FDG PET/CT for initial staging and recurrence detection of head and neck squamous cell carcinoma (HNSCC). METHODS Prospectively, 77 patients with histologically proven or highly suspected HNSCC underwent paired 18F-FDG and 68Ga-FAPI-04 PET/CT in a week for either initial staging (n = 67) or restaging (n = 10). The diagnostic performance was compared for the two imaging approaches, especially for N staging. SUVmax, SUVmean, and target-to-background ratio (TBR) were assessed for paired positive lesions. Furthermore, change in management by 68Ga-FAPI-04 PET/CT and histopathologic FAP expression of some lesions were explored. RESULTS 18F-FDG and 68Ga-FAPI-04 PET/CT exhibited a comparable detection efficiency for primary tumor (100%) and recurrence (62.5%). In the twenty-nine patients receiving neck dissection, 68Ga-FAPI-04 PET/CT showed greater specificity and accuracy in evaluating preoperative N staging than 18F-FDG based on patient (p = 0.031 and p = 0.070), neck side (p = 0.002 and p = 0.006), and neck level (p < 0.001 and p < 0.001). As for distant metastasis, 68Ga-FAPI-04 PET/CT detected more positive lesions than 18F-FDG (25 vs 23) and with higher SUVmax (7.99 ± 9.04 vs 3.62 ± 2.68, p = 0.002) by lesion-based analysis. The type of neck dissection in 9 cases (9/33) was altered by 68Ga-FAPI-04. Overall, clinical management was significantly changed in 10 patients (10/61). Three patients had a follow-up 68Ga-FAPI-04 PET/CT post neoadjuvant therapy: One showed complete remission, and the others showed progression. The 68Ga-FAPI-04 uptake intensity was confirmed to be consistent with FAP expression. CONCLUSION 68Ga-FAPI-04 outperforms 18F-FDG PET/CT in evaluating preoperative N staging in patients with HNSCC. Furthermore, 68Ga-FAPI-04 PET/CT also shows the potential in clinical management and monitoring response to treatment.
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Affiliation(s)
- Yaqun Jiang
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Bing Wen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Chongjiao Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yueli Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Zhiwei Xiao
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Kui Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Diankui Xing
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Zili Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Jing Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Yong He
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.
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7
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Bayley EM, Ivy ML, Shewale JB, Ge PS, Antonoff MB, Francis AM, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Roth JA, Sepesi B, Vaporciyan AA, Walsh GL, Lee JJ, Louie BE, Swisher SG. High-Risk Features of Esophageal Adenocarcinoma Following Neoadjuvant Chemoradiation: Patients for Whom Surgery Should Not Be Delayed. Ann Surg 2023; 277:721-726. [PMID: 36052678 DOI: 10.1097/sla.0000000000005693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Clinical predictors of pathological complete response have not reliably identified patients for whom an organ-sparing approach following neoadjuvant chemoradiation be undertaken for esophageal cancer patients. We sought to identify high-risk predictors of residual carcinoma that may preclude patients from a selective surgical approach. BACKGROUND Patients treated with neoadjuvant chemoradiation followed by esophagectomy for esophageal adenocarcinoma were identified. PATIENTS AND METHODS Correlation between clinical and pathologic complete responses were examined. Regression models and recursive partitioning were utilized to identify features associated with residual carcinoma. External validation of these high-risk factors was performed on a data set from an independent institution. RESULTS A total of 326 patients were identified, in whom clinical complete response was noted in 104/326 (32%). Pathologic complete response was noted in only 33/104 (32%) of these clinical complete responders. Multivariable analysis identified that the presence of stricture ( P =0.011), positive biopsy ( P =0.010), and signet ring cell histology ( P =0.019) were associated with residual cancer. Recursive partitioning corroborated a 94% probability of residual disease, or greater, for each of these features. The positive predictive value was >90% for these characteristics. A SUV max >5.4 at the esophageal primary in the absence of esophagitis was also a high-risk factor for residual carcinoma. External validation confirmed these high-risk factors to be implicated in the finding of residual carcinoma. CONCLUSIONS Clinical parameters of response are poor predictors of complete pathologic response leading to challenges in selecting candidates for active surveillance. However, we characterize several high-risk features for residual carcinoma which indicate that esophagectomy should not be delayed.
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Affiliation(s)
- Erin M Bayley
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Megan L Ivy
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Jitesh B Shewale
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashleigh M Francis
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
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Devaud N, Carroll P. Ongoing Controversies in Esophageal Cancer II. Thorac Surg Clin 2022; 32:553-563. [DOI: 10.1016/j.thorsurg.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Liu XY, Gao Y, Kui XY, Liu XS, Zhang YH, Zhang Y, Ke CB, Pei ZJ. High expression of HNRNPR in ESCA combined with 18F-FDG PET/CT metabolic parameters are novel biomarkers for preoperative diagnosis of ESCA. Lab Invest 2022; 20:450. [PMID: 36195940 PMCID: PMC9533615 DOI: 10.1186/s12967-022-03665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/25/2022] [Indexed: 01/17/2023]
Abstract
Background The aim of this study was to determine the expression and function of heterogeneous nuclear ribonucleoprotein R (HNRNPR) in esophageal carcinoma (ESCA), the correlation between its expression and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computerized tomography scan (PET/CT)-related parameters. We also investigated whether 18F-FDG PET/CT can be used to predict the expression of HNRNPR in ESCA. Methods We analyzed patients with ESCA who underwent 18F-FDG PET/CT before surgery, and their tissues were stained with HNRNPR IHC. The associated parameters were derived using the 18F-FDG PET imaging data, and the correlation with the IHC score was evaluated. The Oncomine, TCGA, and GEO datasets were used to investigate HNRNPR expression in the pan- and esophageal cancers, as well as its relationship with N6-methyladenosine (m6A) modification and glycolysis. The R software, LinkedOmics, GeneMANIA, and StringOnline tools were used to perform GO/KEGG, GGI, and PPI analyses on the HNRNPR. Results HNRNPR is highly expressed in the majority of pan-cancers, including ESCA, and is associated with BMI, weight, and history of reflux in patients with ESCA. HNRNPR is somewhat accurate in predicting the clinical prognosis of ESCA. HNRNPR expression was positively correlated with SUVmax, SUVmean, and TLG in ESCA (p < 0.05). The combination of these three variables provides a strong predictive value for HNRNPR expression in ESCA. GO/KEGG analysis showed that HNRNPR played a role in the regulation of cell cycle, DNA replication, and the Fannie anemia pathway. The analysis of the TCGA and GEO data sets revealed a significant correlation between HNRNPR expression and m6A and glycolysis-related genes. GSEA analysis revealed that HNRNPR was involved in various m6A and glycolysis related-pathways. Conclusion HNRNPR overexpression correlates with 18F-FDG uptake in ESCA and may be involved in the regulation of the cell cycle, m6A modification, and cell glycolysis. 18F-FDG PET/CT-related parameters can predict the diagnostic accuracy of HNRNPR expression in ESCA.
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Affiliation(s)
- Xiao-Yu Liu
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yan Gao
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xue-Yan Kui
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.,Taihe Hospital, Postgraduate Training Basement of Jinzhou Medical University, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xu-Sheng Liu
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yao-Hua Zhang
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yu Zhang
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chang-Bin Ke
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
| | - Zhi-Jun Pei
- Department of Nuclear Medicine and Institute of Anesthesiology and Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China. .,Hubei Key Laboratory of Embryonic Stem Cell Research, Shiyan, Hubei, China.
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10
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Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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11
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PET imaging of esophageal cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Jayaprakasam VS, Paroder V, Schöder H. Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers. Semin Nucl Med 2021; 51:485-501. [PMID: 33965198 PMCID: PMC8338802 DOI: 10.1053/j.semnuclmed.2021.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past two decades, PET/CT has become an essential modality in oncology increasingly used in the management of gastrointestinal (GI) cancers. Most PET/CT tracers used in clinical practice show some degree of GI uptake. This uptake is quite variable and knowledge of common patterns of biodistribution of various radiotracers is helpful in clinical practice. 18F-Fluoro-Deoxy-Glucose (FDG) is the most commonly used radiotracer and has quite a variable uptake within the bowel. 68Ga-Prostate specific membrane antigen (PSMA) shows intense uptake within the proximal small bowel loops. 11C-methyl-L-methionine (MET) shows high accumulation within the bowels, which makes it difficult to assess bowel or pelvic diseases. One must also be aware of technical artifacts causing difficulties in interpretations, such as high attenuation oral contrast material within the bowel lumen or misregistration artifact due to patient movements. It is imperative to know the common variants and benign diseases that can mimic malignant pathologies. Intense FDG uptake within the esophagus and stomach may be a normal variant or may be associated with benign conditions such as esophagitis, reflux disease, or gastritis. Metformin can cause diffuse intense uptake throughout the bowel loops. Intense physiologic uptake can also be seen within the anal canal. Segmental bowel uptake can be seen in inflammatory bowel disease, radiation, or medication induced enteritis/colitis or infection. Diagnosis of appendicitis or diverticular disease requires CT correlation, as normal appendix or diverticulum can show intense uptake. Certain malignant pathologies are known to have only low FDG uptake, such as early-stage esophageal adenocarcinoma, mucinous tumors, indolent lymphomas, and multicystic mesotheliomas. Response assessment, particularly in the neoadjuvant setting, can be limited by post-treatment inflammatory changes. Post-operative complications such as abscess or fistula formation can also show intense uptake and may obscure underlying malignant pathology. In the absence of clinical suspicion or rising tumor marker, the role of FDG PET/CT in routine surveillance of patients with GI malignancy is not clear.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Abstract
Gastrointestinal malignancies encompass a variety of primary tumor sites, each with different staging criteria and treatment approaches. In this review we discuss technical aspects of 18F-FDG-PET/CT scanning to optimize information from both the PET and computed tomography components. Specific applications for 18F-FDG-PET/CT are summarized for initial staging and follow-up of the major disease sites, including esophagus, stomach, hepatobiliary system, pancreas, colon, rectum, and anus.
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Affiliation(s)
- Brandon A Howard
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Terence Z Wong
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA
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Pincet L, Sandre CD, Lang FJW, Colin V. Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience. Int Arch Otorhinolaryngol 2021; 26:e125-e131. [PMID: 35096169 PMCID: PMC8789507 DOI: 10.1055/s-0041-1726049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction
All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves.
Objective
We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed.
Methods
The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope.
Results
In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oro- and hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies.
Conclusion
Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.
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Affiliation(s)
- Laurence Pincet
- Department Department of Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Cécile de Sandre
- Department Department of Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Florian J. W. Lang
- Department of Head and Neck Surgery, Hôpital Cantonal Fribourgeois, Fribourg, Switzerland
| | - Victor Colin
- Department of Head and Neck Surgery, Hôpital Cantonal Fribourgeois, Fribourg, Switzerland
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15
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Lu HH, Chiu NC, Tsai MH. Prognostic Significance of Pretreatment Staging With 18F-FDG PET in Esophageal Cancer: A Nationwide Population-Based Study. Clin Nucl Med 2021; 46:647-653. [PMID: 34034334 PMCID: PMC8257472 DOI: 10.1097/rlu.0000000000003739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/11/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE OF THE REPORT Without the routine use of 18F-FDG PET for initial staging of esophageal cancer, it may lead to inaccurate staging and suboptimal treatment. The purpose of this study was to evaluate the prognostic significance of pretreatment 18F-FDG PET in nonmetastatic esophageal cancer by comparing the survival between patients with and without pretreatment PET. MATERIALS AND METHODS We selected newly diagnosed esophageal cancer patients without metastasis between 2009 and 2015 from Taiwan Cancer Registry and National Health Insurance Research Database. Pretreatment 18F-FDG PET staging was determined according to the implementation of PET within 90 days before starting treatment. Overall survival was calculated from the day of treatment initiation to the death from any cause. Survival curves were compared between patients with and without PET staging using the log-rank test. RESULTS Of the 9078 patients included, 1765 (19.4%) and 7313 (80.6%) patients were staged with and without pretreatment PET, respectively. The median follow-up time for all patients and survivors was 1.29 years and 5.46 years, respectively. The pretreatment PET group had a lower risk of death than the no pretreatment PET group (hazards ratio, 0.74; 95% confidence interval, 0.70-0.79; P < 0.001). After adjusting for age, stage, histology, and tumor location, pretreatment PET remained significantly correlated with a lower risk of death (hazards ratio, 0.78; 95% confidence interval, 0.73-0.83; P < 0.001). CONCLUSIONS The utilization of pretreatment 18F-FDG PET for staging in nonmetastatic esophageal malignancy is associated with a lower risk of death even after adjusting for age, stage, histology, and tumor location.
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Affiliation(s)
- Hsi-Huei Lu
- From the Division of Nuclear Medicine, Department of Medical Imaging
| | - Nan-Ching Chiu
- From the Division of Nuclear Medicine, Department of Medical Imaging
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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King RJ, Qiu F, Yu F, Singh PK. Metabolic and Immunological Subtypes of Esophageal Cancer Reveal Potential Therapeutic Opportunities. Front Cell Dev Biol 2021; 9:667852. [PMID: 34307352 PMCID: PMC8295652 DOI: 10.3389/fcell.2021.667852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Esophageal cancer has the sixth highest rate of cancer-associated deaths worldwide, with many patients displaying metastases and chemotherapy resistance. We sought to find subtypes to see if precision medicine could play a role in finding new potential targets and predicting responses to therapy. Since metabolism not only drives cancers but also serves as a readout, metabolism was examined as a key reporter for differences. METHODS Unsupervised and supervised classification methods, including hierarchical clustering, partial least squares discriminant analysis, k-nearest neighbors, and machine learning techniques, were used to discover and display two major subgroups. Genes, pathways, gene ontologies, survival, and immune differences between the groups were further examined, along with biomarkers between the groups and against normal tissue. RESULTS Esophageal cancer had two major unique metabolic profiles observed between the histological subtypes esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). The metabolic differences suggest that ESCC depends on glycolysis, whereas EAC relies more on oxidative metabolism, catabolism of glycolipids, the tricarboxylic acid (TCA) cycle, and the electron transport chain. We also noted a robust prognostic risk associated with COQ3 expression. In addition to the metabolic alterations, we noted significant alterations in key pathways regulating immunity, including alterations in cytokines and predicted immune infiltration. ESCC appears to have increased signature associated with dendritic cells, Th17, and CD8 T cells, the latter of which correlate with survival in ESCC. We bioinformatically observed that ESCC may be more responsive to checkpoint inhibitor therapy than EAC and postulate targets to enhance therapy further. Lastly, we highlight correlations between differentially expressed enzymes and the potential immune status. CONCLUSION Overall, these results highlight the extreme differences observed between the histological subtypes and may lead to novel biomarkers, therapeutic strategies, and differences in therapeutic response for targeting each esophageal cancer subtype.
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Affiliation(s)
- Ryan J. King
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, United States
| | - Fang Qiu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Pankaj K. Singh
- The Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
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Shemmeri E, Fabian T. Staging of Esophageal Malignancy. Surg Clin North Am 2021; 101:405-414. [PMID: 34048761 DOI: 10.1016/j.suc.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Optimal treatment of esophageal cancer is a complex process dependent on many factors, including stage at diagnosis, medical fitness, physician judgment, and expertise. Despite significant advances in understanding of this cancer, survival remains low. Identifying patients with early-stage disease can enhance their outcomes dramatically. On a broader scale, staging is critical in advancing the quality of care delivered to these patients now and in the future. This article is designed to review clinicians' expertise with staging and to elaborate on the nuances frequently encountered when doing so.
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Affiliation(s)
- Ealaf Shemmeri
- Section of Thoracic Surgery, Department of Surgery, Albany Medical College, 3rd Floor, 50 New Scotland Avenue, Albany, NY 12208, USA.
| | - Thomas Fabian
- Section of Thoracic Surgery, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
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18
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Betancourt-Cuellar SL, Benveniste MFK, Palacio DP, Hofstetter WL. Esophageal Cancer: Tumor-Node-Metastasis Staging. Radiol Clin North Am 2021; 59:219-229. [PMID: 33551083 DOI: 10.1016/j.rcl.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Esophageal cancer is an uncommon malignancy that ranks sixth in terms of mortality worldwide. Squamous cell carcinoma is the predominant histologic subtype worldwide whereas adenocarcinoma represents the majority of cases in North America, Australia, and Europe. Esophageal cancer is staged using the American Joint Committee on Cancer and the International Union for Cancer Control TNM system and has separate classifications for the clinical, pathologic, and postneoadjuvant pathologic stage groups. The determination of clinical TNM is based on complementary imaging modalities, including esophagogastroduodenoscopy/endoscopic ultrasound; endoscopic ultrasound-fine-needle aspiration; computed tomography of the chest, abdomen, and pelvis; and fluorodeoxyglucose PET/computed tomography.
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Affiliation(s)
- Sonia L Betancourt-Cuellar
- Thoracic Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4009, USA.
| | - Marcelo F K Benveniste
- Thoracic Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4009, USA
| | - Diana P Palacio
- Department of Medical Imaging, The University of Arizona - Banner Medical Center, 1501 North Campbell Avenue, PO BOX 245067, Tucson, AZ 85724, USA
| | - Wayne L Hofstetter
- Cardiothoracic Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030-4009, USA
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Foley KG, Pearson B, Riddell Z, Taylor SA. Opportunities in cancer imaging: a review of oesophageal, gastric and colorectal malignancies. Clin Radiol 2021; 76:748-762. [PMID: 33579518 DOI: 10.1016/j.crad.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
The incidence of gastrointestinal (GI) malignancy is increasing worldwide. In particular, there is a concerning rise in incidence of GI cancer in younger adults. Direct endoscopic visualisation of luminal tumour sites requires invasive procedures, which are associated with certain risks, but remain necessary because of limitations in current imaging techniques and the continuing need to obtain tissue for diagnosis and genetic analysis; however, management of GI cancer is increasingly reliant on non-invasive, radiological imaging to diagnose, stage, and treat these malignancies. Oesophageal, gastric, and colorectal malignancies require specialist investigation and treatment due to the complex nature of the anatomy, biology, and subsequent treatment strategies. As cancer imaging techniques develop, many opportunities to improve tumour detection, diagnostic accuracy and treatment monitoring present themselves. This review article aims to report current imaging practice, advances in various radiological modalities in relation to GI luminal tumour sites and describes opportunities for GI radiologists to improve patient outcomes.
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Affiliation(s)
- K G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK.
| | - B Pearson
- National Imaging Academy Wales (NIAW), Pencoed, UK
| | - Z Riddell
- National Imaging Academy Wales (NIAW), Pencoed, UK
| | - S A Taylor
- Centre for Medical Imaging, UCL, London, UK
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20
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Role of Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in the Management of Barrett's Related Neoplasia. Gastrointest Endosc Clin N Am 2021; 31:171-182. [PMID: 33213794 DOI: 10.1016/j.giec.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic resection has been proven to be safe and highly effective for removing early neoplastic lesions in Barrett esophagus. It enables accurate histopathological assessment and is therefore considered as the cornerstone in the endoscopic work-up for patients with Barrett neoplasia. Various techniques are available to perform endoscopic resection. Multiband mucosectomy is the most commonly used resection technique. However, endoscopic submucosal dissection is gaining ground in the Western world. Endoscopic resection for low-risk submucosal lesions already is fully justified. Future studies have to point out whether endoscopic resection and subsequent follow-up are also justified in selected patients with high-risk submucosal tumors.
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21
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Guan Y, Wang J, Cao F, Chen X, Wang Y, Jiang S, Zhang D, Zhang W, Guo Z, Wang P, Pang Q. Role of clip markers placed by endoscopic ultrasonography in contouring gross tumor volume for thoracic esophageal squamous cell carcinoma: one prospective study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1144. [PMID: 33240993 PMCID: PMC7576083 DOI: 10.21037/atm-20-4030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background We aimed to analyze the value of metal clip markers guided and placed by endoscopic ultrasonography (EUS) in the delineation of gross tumor volume (GTV) for thoracic esophageal squamous cell carcinoma. Methods From September 2016 to September 2018, patients with thoracic esophageal squamous cell carcinoma in Tianjin Medical University Cancer Institute and Hospital were recruited in the prospective trial, NCT02959385. They underwent titanium clips placement on tumor superior and inferior boundaries under EUS by a single expert endosonographer before radiotherapy computed tomography (CT) simulation. According to the clip markers, the reference GTVs were contoured by one experienced radiation oncologist. With the help of the Eclipse treatment planning system, clip markers on CT were concealed. Afterward, two other radiation oncologists with expertise in esophageal cancer delineated GTVs, defined as conventional GTVs, based on endoscopy and barium radiography findings. The two GTVs were compared and analyzed. Subgroup analysis was conducted in different T stage [early (T1 + T2) vs. advanced (T3 + T4)], focus location (upper vs. middle vs. lower segment), and tumor length (<5 vs. >5 cm) groups. Results The trial recruited 55 patients with 60 thoracic esophageal cancer foci. A total of 111 titanium clips were guided and implanted by EUS. Before CT simulation, two titanium clips at two foci fell off. After the procedure, no case of intolerable esophageal pain, hemorrhage, or perforation occurred. Compared to reference GTVs’, discrepancies of conventional GTVs’ superior borders were 0.91±0.82 cm (P<0.001), while differences of inferior borders were 0.74±0.63 cm (P<0.001). On the contrary, conventional GTVs’ lengths were not significantly different from reference GTVs’ with discrepancies 0.08±1.30 cm (P=0.64). Regardless of T stage, tumor location, and tumor length, conventional GTVs’ superior and inferior borders were significantly different from reference GTVs’, while GTVs’ lengths differed insignificantly. Conclusions This study confirmed that EUS-placed titanium clips could correct contouring of GTVs in thoracic esophageal cancer in different T stages, tumor locations, and lengths.
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Affiliation(s)
- Yong Guan
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jing Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Fuliang Cao
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Chen
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yuwen Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Shengpeng Jiang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Daguang Zhang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wencheng Zhang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhoubo Guo
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qingsong Pang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Bhatt A, Kamath S, Murthy SC, Raja S. Multidisciplinary Evaluation and Management of Early Stage Esophageal Cancer. Surg Oncol Clin N Am 2020; 29:613-630. [PMID: 32883462 DOI: 10.1016/j.soc.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Early esophageal cancer involves the mucosal and submucosal layers of the esophagus. Early esophageal cancer is a heterogeneous group, and achieving optimal outcomes requires a multidisciplinary approach to align patients to their optimal treatment. Although organ-sparing endoscopic resection has become the preferred management option for superficial esophageal cancer, it is not adequate in all tumors, such as high-risk lesions with poorly differentiated pathology, lymphovascular invasion, or deep submucosal invasion. In such high-risk lesions, surgery, chemotherapy, and/or radiation may be required. In this article, we present our multidisciplinary approach to early esophageal cancer.
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Affiliation(s)
- Amit Bhatt
- Department of Gastroenterology and Hepatology, A31 desk, Cleveland, Ohio 44195, USA.
| | - Suneel Kamath
- Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, J4-1, 9500 Euclid Ave, Cleveland, Ohio 44195, USA
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, J4-1, 9500 Euclid Ave, Cleveland, Ohio 44195, USA
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Li XF, Wang Q, Duan SF, Yao B, Liu CY. Heterogeneity of T3 stage esophageal squamous cell carcinoma in different parts based on enhanced CT radiomics. Medicine (Baltimore) 2020; 99:e21470. [PMID: 32769880 PMCID: PMC7593053 DOI: 10.1097/md.0000000000021470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Esophageal cancer is a common malignant tumor of the digestive system with a high incidence and a poor prognosis. At the present, CT-based radiomics is providing more and more valuable information. However, the heterogeneity of the study and the poor repeatability of the texture feature parameters have limited its wider clinical application. In the present study, we focused on comparing the differences in the texture features of T3 stage esophageal squamous cell carcinoma at different locations and normal esophageal wall, aiming to provide some pieces of useful information for future research on esophageal squamous cell carcinoma.Fifty seven cases with throat CT imaging, including esophageal cancer contrast enhanced CT and conventional CT of healthy control group. The texture characteristics in control group and tumor group among different parts were compared. Using Univariable analysis, we compared the difference and conducted receiver-operator curve analysis to evaluate the performance of tumor grade diagnosis model.53 radiomic features were significantly different in control group and so as 93 features for tumor group. The upper section was the mostly different from the other 2 sections. Run-length matrix (RLM) features in tumor group accounted for the highest proportion, only Surface Volume Ratio was different.There are differences in the texture features of the tube wall in different parts of the esophagus of healthy adults, and this difference is more obvious in pT3 stage esophageal squamous cell carcinoma. In the future radiomics study of esophageal squamous cell carcinoma, we need to pay attention to this to avoid affecting the accuracy of the results.
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Affiliation(s)
| | - Qiang Wang
- Department of Radiotherapy, Xuzhou Cancer Hospital, Xuzhou, Jiangsu Province
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Jeong DY, Lee KS, Choi JY, Chung MJ, Min YW, Kim HK, Zo JI, Shim YM, Sun JM. Surgically Resected Esophageal Squamous Cell Carcinoma: Patient Survival and Clinicopathological Prognostic Factors. Sci Rep 2020; 10:5077. [PMID: 32193500 PMCID: PMC7081270 DOI: 10.1038/s41598-020-62028-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/06/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed to report patients' survival after surgical resection of eSCC and to ascertain the clinical, imaging, and pathological factors related to patient prognosis. This retrospective study included 435 patients with eSCC of <stage T2 (median follow-up period, 49.3 months). A total of 103 (23.7%) patients died, and 89 (20.5%) experienced recurrence during follow-up. The maximum standardized uptake value (SUVmax) on positron emission tomography (PET)/computed tomography (CT) of the primary tumor was significantly correlated with tumor length, nodal metastasis, and pathologic T stage in a positive linear fashion. In the multivariate analysis, higher SUVmax on PET/CT was a negative prognostic factor for both disease-free survival (DFS) and overall survival (OS). Contrarily, the presence of nodal metastasis was a prognostic factor only for DFS, and pathologic T stage only for OS. By applying SUVmax cut-off, both DFS and OS were significantly different among three groups when divided by cut-off values (A: SUVmax ≤ 3.05, B: SUVmax 3.06 - 5.64, C: SUVmax ≥ 5.65). In patients with a surgically resectable eSCC, measuring the SUVmax of the primary tumor during PET/CT can help predict patient survival. Additionally, PET/CT renders triage criterion for endoscopic submucosal dissection (ESD; T1a cancer and SUVmax, ≤3.05).
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Affiliation(s)
- Dong Young Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea.
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Jong-Mu Sun
- Division of Hemato-oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
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26
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Hofstetter W. Commentary: Fluorodeoxyglucose-positron emission tomography/computed tomography for cervical adenopathy in esophageal carcinoma, an option for the selective surgeon. J Thorac Cardiovasc Surg 2020; 160:551-552. [PMID: 31955937 DOI: 10.1016/j.jtcvs.2019.11.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Tex
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Prätherapeutische Fehlklassifikationen bei Ösophaguskarzinomen und Adenokarzinomen des ösophagogastralen Übergangs. Chirurg 2020; 91:41-50. [DOI: 10.1007/s00104-019-1011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Li B, Li N, Liu S, Li Y, Qian B, Zhang Y, He H, Chen X, Sun Y, Xiang J, Hu H, Chen H. Does [18F] fluorodeoxyglucose-positron emission tomography/computed tomography have a role in cervical nodal staging for esophageal squamous cell carcinoma? J Thorac Cardiovasc Surg 2019; 160:544-550. [PMID: 31932053 DOI: 10.1016/j.jtcvs.2019.11.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Accurate nodal staging is crucial for esophageal cancer. A prospective study was performed to assess the value of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for diagnosing cervical lymph node metastasis (LNM) of esophageal squamous cell carcinoma. METHODS From June 2018 to November 2018, 110 patients with resectable esophageal cancer were prospectively enrolled. Esophagectomy with 3-field lymphadenectomy was performed after FDG-PET/CT scanning. The primary end point was cervical LNM determined via postoperative histologic examination. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) of FDG-PET/CT for the assessment of LNM were determined using histologic results as reference standards. RESULTS Positive lymph nodes as determined via FDG-PET/CT were detected in 61 patients (55.5%), of whom 13 (11.8%) had positive cervical lymph nodes. After surgery, 59 patients (53.6%) exhibited pathologic LNM, of whom 20 (18.2%) had cervical LNM. SE, SP, PPV, NPV, and AC were 65.6%, 61.2%, 67.8%, 58.8%, and 63.6%, respectively, with regards to diagnosing overall LNM, and were 45.0%, 95.6%, 69.2%, 88.7%, and 86.4%, respectively, for diagnosing cervical LNM. Of the 110 patients, 90 underwent both FDG-PET/CT scanning and ultrasonography in the neck, and there were no significant differences in SE, SP, PPV, NPV, or AC with respect to cervical LNM diagnosis between FDG-PET/CT and ultrasonography. CONCLUSIONS For cervical LNM of esophageal squamous cell carcinoma, FDG-PET/CT scanning exhibited high specificity but low sensitivity, suggesting that it is of limited value for this purpose.
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Affiliation(s)
- Bin Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Beijing, China
| | - Bin Qian
- Department of Thoracic Surgery, Jiangdu People's Hospital of Yangzhou, Jiangdu, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hao He
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xiankai Chen
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Beijing, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Lopci E, Kauppi J, Lugaresi M, Mattioli B, Daddi N, Fortunato F, Rasanen J, Mattioli S. Siewert type I and II oesophageal adenocarcinoma: sensitivity/specificity of computed tomography, positron emission tomography and endoscopic ultrasound for assessment of lymph node metastases in groups of thoracic and abdominal lymph node stations. Interact Cardiovasc Thorac Surg 2019; 28:518-525. [PMID: 30496443 DOI: 10.1093/icvts/ivy314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES In Siewert type I/II oesophageal adenocarcinoma, the sensitivity and specificity of computed tomography (CT), positron emission tomography (PET)-CT and endoscopic ultrasound (EUS) for assessment of the N descriptor in defined groups of lymph nodes were investigated. METHODS CT, PET/CT, EUS images and the pathological data of 101 oesophageal adenocarcinomas submitted to primary resection were compared. The lymph nodes were identified as (a) right paratracheal/subcarinal/pulmonary ligament; (b) paraoesophageal; (c) paracardial; (d) left gastric artery, lesser curvature; (e) coeliac trunk, hepatic/splenic artery. RESULTS Of the 2451 lymph nodes identified, 273 (11.1%) were histologically positive. Overall sensitivity, specificity and negative and positive predictive value for detection of lymph nodes metastatic were respectively: CT sensitivity 39%, specificity 86%, negative 58% and positive 74% predictive value; PET/CT sensitivity 30%, specificity 98%, negative 58% and positive 93% predictive value; EUS sensitivity 50%, specificity 81%, negative 72% and positive 62% predictive value. The sensitivity of CT, PET/CT and EUS in the thoracic nodal groups (a) and (b) was, respectively, 58.3%, 7.1% and 87.5% and 33.3%, 20% and 80%. Sensitivity was below 47% for all tests in the abdominal nodal groups. In contrast, specificity (88.6-100%) was super imposable in all nodal groups. The strength of agreement among the 3 imaging techniques was poor (kappa < 0.30) for the thoracic anatomical groups of interest: (a) lower paratracheal/subcarinal/pulmonary ligament and (b) paraoesophageal; it was moderate/good (kappa >0.30) for the abdominal N groups of interest: c, d and e. CONCLUSIONS The diagnostic performance of CT, PET and EUS for assessing the N descriptor in the paracardial and abdominal stations close to the primary tumour is not satisfactory. EUS can efficiently assess the presence/absence of nodal metastases in the thoracic stations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov number: NCT03529968.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Italy.,PhD Course in Cardio-Nephro-Thoracic Sciences University of Bologna, Bologna, Italy
| | - Juha Kauppi
- Department of General Thoracic and Oesophageal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Marialuisa Lugaresi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Division of Thoracic Surgery, Maria Cecilia Hospital, Cotignola, Italy
| | - Benedetta Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Niccolò Daddi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Jari Rasanen
- Department of General Thoracic and Oesophageal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sandro Mattioli
- PhD Course in Cardio-Nephro-Thoracic Sciences University of Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Division of Thoracic Surgery, Maria Cecilia Hospital, Cotignola, Italy
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Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review. Clin Gastroenterol Hepatol 2019; 17:2161-2166. [PMID: 31401148 DOI: 10.1016/j.cgh.2019.05.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/03/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
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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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Heiden BT, Patel N, Nancarrow DJ, Hermann M, Brown RKJ, Orringer MB, Lin J, Chang AC, Carrott PW, Lynch WR, Zhao L, Beer DG, Reddy RM. Positron Emission Tomography 18F-Fluorodeoxyglucose Uptake Correlates with KRAS and EMT Gene Signatures in Operable Esophageal Adenocarcinoma. J Surg Res 2018; 232:621-628. [PMID: 30463782 DOI: 10.1016/j.jss.2018.06.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/08/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND 18F-fluorodeoxyglucose positron emission tomography is an imaging modality critical to the diagnosis and staging of esophageal cancer. Despite this, the genetic abnormalities associated with increased 18F-fluorodeoxyglucose (FDG)-maximum standardized uptake value (SUVmax) have not been previously explored in esophageal adenocarcinoma. MATERIALS AND METHODS Treatment-naïve patients, for whom frozen tissue and 18F-fluorodeoxyglucose positron emission tomography data were available, undergoing esophagectomy from 2003 to 2012, were identified. Primary tumor FDG-uptake (SUVmax) was quantified as low (<5), moderate, or high (>10). Genome-wide expression analyses (e.g., microarray) were used to examine gene expression differences associated with FDG-uptake. RESULTS Eighteen patients with stored positron emission tomography data and tissue were reviewed. Overall survival was similar between patients with high (n = 9) and low (n = 6) FDG-uptake tumors (P = 0.71). Differences in gene expression between tumors with high and low FDG-uptake included enriched expression of various matrix metalloproteinases, extracellular-matrix components, oncogenic signaling members, and PD-L1 (fold-change>2.0, P < 0.05) among the high-FDG tumors. Glycolytic gene expression and pathway involvement were similar between the high- and low-FDG tumor subsets (P = 0.126). Gene ontology analysis of the most differentially expressed genes demonstrated significant upregulation of gene sets associated with extracellular matrix organization and vascular development (P < 0.005). Gene set enrichment analysis further demonstrated associations between FDG-uptake intensity and canonical oncogenic processes, including hypoxia, angiogenesis, KRAS signaling, and epithelial-to-mesenchymal transition (P < 0.001). Interestingly, KRAS expression did not predict worse survival in a larger cohort (n = 104) of esophageal adenocarcinomas (P = 0.64). CONCLUSIONS These results suggest that elevated FDG-uptake is associated with a variety of oncogenic alterations in operable esophageal adenocarcinoma. These pathways present potential therapeutic targets among tumors exhibiting high FDG-uptake.
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Affiliation(s)
- Brendan T Heiden
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nathan Patel
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Derek J Nancarrow
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew Hermann
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Richard K J Brown
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Mark B Orringer
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jules Lin
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew C Chang
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Philip W Carrott
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - William R Lynch
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Biostatistics Unit, University of Michigan Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - David G Beer
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rishindra M Reddy
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
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Jeong DY, Kim MY, Lee KS, Choi JY, Kim SJ, Chung MJ, Min YW, Kim HK, Zo JI, Shim YM, Sun J. Surgically resected T1- and T2-stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT. Cancer Med 2018; 7:3561-3570. [PMID: 29932307 PMCID: PMC6089181 DOI: 10.1002/cam4.1617] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/24/2018] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Dong Young Jeong
- Department of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Min Yeong Kim
- Department of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyung Soo Lee
- Department of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Joon Young Choi
- Department of Nuclear MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Soo Jeong Kim
- Department of Nuclear MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Myung Jin Chung
- Department of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Yang Won Min
- Division of GastroenterologyDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Hong Kwan Kim
- Department of Thoracic SurgerySamsung Medical CenterSungkyunkwan University School of Medicine (SKKU‐SOM)SeoulKorea
| | - Jae Ill Zo
- Department of Thoracic SurgerySamsung Medical CenterSungkyunkwan University School of Medicine (SKKU‐SOM)SeoulKorea
| | - Young Mog Shim
- Department of Thoracic SurgerySamsung Medical CenterSungkyunkwan University School of Medicine (SKKU‐SOM)SeoulKorea
| | - Jong‐Mu Sun
- Division of Hemato‐oncologyDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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DaVee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer? World J Gastroenterol 2017; 23:751-762. [PMID: 28223720 PMCID: PMC5296192 DOI: 10.3748/wjg.v23.i5.751] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/23/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.
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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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Betancourt Cuellar SL, Sabloff B, Carter BW, Benveniste MF, Correa AM, Maru DM, Ajani JA, Erasmus JJ, Hofstetter WL. Early clinical esophageal adenocarcinoma (cT1): Utility of CT in regional nodal metastasis detection and can the clinical accuracy be improved? Eur J Radiol 2017; 88:56-60. [PMID: 28189209 DOI: 10.1016/j.ejrad.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Treatment of early esophageal cancer depends on the extent of the primary tumor and presence of regional lymph node metastasis.(RNM). Short axis diameter>10mm is typically used to detect RNM. However, clinical determination of RNM is inaccurate and can result in inappropriate treatment. Purpose of this study is to evaluate the accuracy of a single linear measurement (short axis>10mm) of regional nodes on CT in predicting nodal metastasis, in patients with early esophageal cancer and whether using a mean diameter value (short axis+long axis/2) as well as nodal shape improves cN designation. METHODS CTs of 49 patients with cT1 adenocarcinoma treated with surgical resection alone were reviewed retrospectively. Regional nodes were considered positive for malignancy when round or ovoid and mean size>5mm adjacent to the primary tumor and>7mm when not adjacent. Results were compared with pN status after esophagectomy. RESULTS 18/49 patients had pN+ at resection. Using a single short axis diameter>10mm on CT, nodal metastasis (cN) was positive in 7/49. Only 1 of these patients was pN+ at resection (sensitivity 5%, specificity 80%, accuracy 53%). Using mean size and morphologic criteria, cN was positive in 28/49. 11 of these patients were pN+ at resection (sensitivity 61%, specificity 45%, accuracy 51%). EUS with limited FNA of regional nodes resulted in 16/49 patients with pN+ being inappropriately designated as cN0. CONCLUSIONS Evaluation of size, shape and location of regional lymph nodes on CT improves the sensitivity of cN determination compared with a short axis measurement alone in patients with cT1 esophageal cancer, although clinical utility is limited.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Bradley Sabloff
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Brett W Carter
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Marcelo F Benveniste
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Arlene M Correa
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Dipen M Maru
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Jaffer A Ajani
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Jeremy J Erasmus
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
| | - Wayne L Hofstetter
- The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States.
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Mansfield SA, El-Dika S, Krishna SG, Perry KA, Walker JP. Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions. Surg Endosc 2016; 31:3227-3233. [PMID: 27864719 DOI: 10.1007/s00464-016-5351-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) has been routinely utilized for the locoregional staging of esophageal cancer. One important aspect of clinical staging has been to stratify patients to treatment with neoadjuvant chemoradiation or primary surgical therapy. We hypothesized that EUS may have a limited impact on clinical decision making in patients with dysphagia and obstructing esophageal masses. METHODS This retrospective cohort study included all patients with esophageal adenocarcinoma undergoing esophageal EUS between July 2008 and September 2013. Dysplastic Barrett's esophagus without invasive adenocarcinoma or incomplete staging was excluded. Patient demographics, endoscopic tumor characteristics, the presence of dysphagia, sonographic staging, and post-EUS therapy were recorded. Pathologic staging for patients who underwent primary surgical therapy was also recorded. Locally advanced disease was defined as at least T3 or N1, as these patients are typically treated with neoadjuvant therapy. RESULTS Two hundred sixteen patients underwent EUS for esophageal adenocarcinoma, with 147 (68.1%) patients having symptoms of dysphagia on initial presentation. Patients with dysphagia were significantly more likely to have locally advanced disease on EUS than patients without dysphagia (p < 0.0001). Additionally, 145 (67.1%) patients had a partially or completely obstructing mass on initial endoscopy, of which 136 (93.8%) were locally advanced (p < 0.0001 vs. non-obstructing lesions). CONCLUSIONS An overwhelming majority of patients presenting with dysphagia and/or the presence of at least partially obstructing esophageal mass at the time of esophageal cancer diagnosis had an EUS that demonstrated at least locally advanced disease. The present study supports the hypothesis that EUS may be of limited benefit for management of esophageal cancer in patients with an obstructing mass and dysphagia.
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Affiliation(s)
- Sara A Mansfield
- General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samer El-Dika
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Somashekar G Krishna
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Kyle A Perry
- General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jon P Walker
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA.
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FDG-PET/CT lymph node staging after neoadjuvant chemotherapy in patients with adenocarcinoma of the esophageal-gastric junction. Abdom Radiol (NY) 2016; 41:2089-2094. [PMID: 27405645 PMCID: PMC5059406 DOI: 10.1007/s00261-016-0820-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives The aim of the analysis was to assess the accuracy of various FDG-PET/CT parameters in staging lymph nodes after neoadjuvant chemotherapy. Methods In this prospective study, 74 patients with adenocarcinoma of the esophageal–gastric junction were examined by FDG-PET/CT in the course of their neoadjuvant chemotherapy given before surgical treatment. Data from the final FDG-PET/CT examinations were compared with the histology from the surgical specimens (gold standard). The accuracy was calculated for four FDG-PET/CT parameters: (1) hypermetabolic nodes, (2) large nodes, (3) large-and-medium large nodes, and (4) hypermetabolic or large nodes. Results In 74 patients, a total of 1540 lymph nodes were obtained by surgery, and these were grouped into 287 regions according to topographic origin. Five hundred and two nodes were imaged by FDG-PET/CT and were grouped into these same regions for comparison. In the analysis, (1) hypermetabolic nodes, (2) large nodes, (3) large-and-medium large nodes, and (4) hypermetabolic or large nodes identified metastases in particular regions with sensitivities of 11.6%, 2.9%, 21.7%, and 13.0%, respectively; specificity was 98.6%, 94.5%, 74.8%, and 93.6%, respectively. The best accuracy of 77.7% reached the parameter of hypermetabolic nodes. Accuracy decreased to 62.0% when also smaller nodes (medium-large) were taken for the parameter of metastases. Conclusions FDG-PET/CT proved low sensitivity and high specificity. Low sensitivity was based on low detection rate (32.6%) when compared nodes imaged by FDG-PET/CT to nodes found by surgery, and in inability to detect micrometastases. Sensitivity increased when also medium-large LNs were taken for positive, but specificity and accuracy decreased.
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Savarino E, Ottonello A, Tolone S, Bartolo O, Baeg MK, Farjah F, Kuribayashi S, Shetler KP, Lottrup C, Stein E. Novel insights into esophageal diagnostic procedures. Ann N Y Acad Sci 2016; 1380:162-177. [PMID: 27681220 DOI: 10.1111/nyas.13255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
The 21st century offers new advances in diagnostic procedures and protocols in the management of esophageal diseases. This review highlights the most recent advances in esophageal diagnostic technologies, including clinical applications of novel endoscopic devices, such as ultrathin endoscopy and confocal laser endomicroscopy for diagnosis and management of Barrett's esophagus; novel parameters and protocols in high-resolution esophageal manometry for the identification and better classification of motility abnormalities; innovative connections between esophageal motility disorder diagnosis and detection of gastroesophageal reflux disease (GERD); impedance-pH testing for detecting the various GERD phenotypes; performance of distensibility testing for better pathophysiological knowledge of the esophagus and other gastrointestinal abnormalities; and a modern view of positron emission tomography scanning in metastatic disease detection in the era of accountability as a model for examining other new technologies. We now have better tools than ever for the detection of esophageal diseases and disorders, and emerging data are helping to define how well these tools change management and provide value to clinicians. This review features novel insights from multidisciplinary perspectives, including both surgical and medical perspectives, into these new tools, and it offers guidance on the use of novel technologies in clinical practice and future directions for research.
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Affiliation(s)
- Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Andrea Ottonello
- Department of Surgical and Diagnostic Integrated Sciences, University of Genoa, Genoa, Italy
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Ottavia Bartolo
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Myong Ki Baeg
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, South Korea
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan
| | - Katerina P Shetler
- Division of Gastroenterology, Palo Alto Medical Foundation, Mountain View, California
| | - Christian Lottrup
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.,Department of Medicine, North Jutland Regional Hospital, Hjørring, Denmark
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Simianu VV, Varghese TK, Flanagan MR, Flum DR, Shankaran V, Oelschlager BK, Mulligan MS, Wood DE, Pellegrini CA, Farjah F. Positron emission tomography for initial staging of esophageal cancer among medicare beneficiaries. J Gastrointest Oncol 2016; 7:395-402. [PMID: 27284472 DOI: 10.21037/jgo.2015.10.03] [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] Open
Abstract
BACKGROUND The role of positron emission tomography (PET) in the initial staging of esophageal cancer is to detect occult metastases, but its ability to do so has not been evaluated at the population-level. In 2001, Medicare approved reimbursement of PET for esophageal cancer staging. We hypothesized rapid adoption of PET after 2001 and a coincident increase in the prevalence of stage IV disease. METHODS A retrospective cohort study [1997-2009] was conducted of 12,870 Medicare beneficiaries with esophageal cancer using the Surveillance, Epidemiology, and End-Results (SEER)-Medicare database. RESULTS PET use increased from <3% before 2001 to 44% in 2009 (post-PET era) (P trend <0.001). Over the same period, the prevalence of stage IV disease also increased (20% in 1997 and 28% in 2009, P trend <0.001). After adjusting for changing patient characteristics over time, the rate of increase in stage IV disease in the post-PET era [relative risk (RR) =1.06; 95% confidence interval (CI), 1.00-1.13] was no different than the rate of increase in the pre-PET era (RR =1.02; 95% CI, 1.02-1.04). Over the entire study period, the prevalence of unrecorded stage decreased by more than half (43% to 18%, adjusted P trend <0.001) with coincident increases in stage 0-III (37% to 53%, adjusted P trend <0.001) as well as stage IV disease. CONCLUSIONS The increasing frequency of PET use and stage IV disease over time is more likely explained by improved documentation rather than PET's ability to detect occult metastases. The absence of compelling population-level impact compliments previous studies, revealing an opportunity to increase value through selective use of PET.
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Affiliation(s)
- Vlad V Simianu
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas K Varghese
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Meghan R Flanagan
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - David R Flum
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Veena Shankaran
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Brant K Oelschlager
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael S Mulligan
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Douglas E Wood
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carlos A Pellegrini
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Farhood Farjah
- 1 Division of General Surgery, Department of Surgery, 2 Surgical Outcomes Research Center (SORCE), 3 Division of Cardiothoracic Surgery, Department of Surgery, 4 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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Park JK, Kim JJ, Moon SW. A study about different findings of PET-CT between neoadjuvant and non-neoadjuvant therapy: SUVmax is not a reliable predictor of lymphatic involvement after neoadjuvant therapy for esophageal cancer. J Thorac Dis 2016; 8:784-94. [PMID: 27162651 DOI: 10.21037/jtd.2016.03.20] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND No definitive findings or established guidelines have been published for the evaluation of esophageal tumors (tumor) and regional lymph nodes (LN) using positron emission tomography computed tomography (PET-CT) in patients with esophageal cancer. In addition, it remains unclear whether PET-CT findings vary between neoadjuvant (NT) and non-neoadjuvant (non-NT) therapy cases. Therefore, preoperative evaluation using PET-CT might provide unreliable information and influence the management plan for esophageal cancer. The purpose of the present study is to clarify the different findings of PET-CT between NT and non-NT in surgical esophageal cancer cases and to predict LN metastasis. METHODS We retrospectively reviewed the medical records of 192 consecutive cases that met this study's inclusion criteria from January 2009 to December 2014. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer at the department of thoracic and cardiovascular surgery in a single tertiary Korean hospital. We compiled and analyzed maximum standard uptake values (SUVmax) of tumor and LNs with other clinical information (chronic lung disease, history of previous other primary cancer, sex, pathological findings, NT, and other clinical data). RESULTS (I) In NT, a positive correlation between T stage and SUVmax was found (tumor SUVmax P<0.001, LN SUVmax P=0.010); however, no relationship between N stage and SUVmax was found. In non-NT, a positive correlation between pathological stage (T and N stage) and SUVmax was found (T stage, tumor SUVmax P<0.001, LN SUVmax P=0.001; N stage, tumor SUVmax P=0.003, LN SUVmax P=0.021); (II) In NT, the low SUVmax group had higher disease-free survival (DFS) and overall survival (OS) than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.142; OS, tumor SUVmax P<0.001, LN SUVmax P=0.002). In non-NT, the low SUVmax group also had higher DFS and OS than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.008; OS, tumor SUVmax P=0.029, LN SUVmax P=0.016). SUVmax values being equal, non-NT had significantly higher DFS and OS than NT (P=0.011, P=0.009, respectively), despite the absence of significant differences in pathological stage; (III) Tumor SUVmax had a positive correlation with LN SUVmax in both NT and non-NT (P=0.006, P<0.001, respectively); (IV) In NT, there were no diagnostic findings of LN metastases using SUVmax. However, in non-NT, significant cutoff values for diagnosis of LN metastases using both tumor and LN SUVmax were found (tumor SUVmax cutoff value 4.9, P=0.008; LN SUVmax cutoff value 2.5, P=0.045); (V) In NT, there was no significant difference in LN SUVmax between pathologically negative and positive LNs. However, in non-NT, the LN SUVmax of pathologically positive LNs was significantly higher than that of pathologically negative LNs (P=0.042); (VI) There were no significant differences in tumor and LN SUVmax according to various factors, including chronic lung disease (COPD, bronchiectasis), age, previous cancers, and sex, regardless of NT. CONCLUSIONS This study showed that there were some different findings of PET-CT using SUVmax between NT and non-NT. These findings should be clarified for further evaluation and management, especially of surgery, which should not be withheld out of ignorance of these different PET-CT findings and should be considered carefully in conjunction with other conditions. In addition, further studies about the effects of NT on PET-CT findings are required to improve the utility of PET-CT to evaluate the LNs in esophageal cancer.
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Affiliation(s)
- Jae Kil Park
- 1 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, 2 Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu City, Gyeonggi-do 480-717, Korea
| | - Jae Jun Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, 2 Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu City, Gyeonggi-do 480-717, Korea
| | - Seok Whan Moon
- 1 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, 2 Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu City, Gyeonggi-do 480-717, Korea
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Qi X, Li M, Zhao S, Luo J, Shao Y, Zhang Z, Chen Y. Prevalence of metastasis in T1b esophageal squamous cell carcinoma: a retrospective analysis of 258 Chinese patients. J Thorac Dis 2016; 8:966-76. [PMID: 27162673 PMCID: PMC4842799 DOI: 10.21037/jtd.2016.03.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/01/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND There is controversy regarding the impact of different depths of submucosal invasion on lymph node metastasis (LNM) and overall survival (OS). We evaluated the impact of depth of submucosal invasion on the presence of metastatic lymphadenopathy and survival in a Chinese population with esophageal squamous cell carcinoma (ESCC). METHODS A total of 258 patients who underwent esophagectomy from November 2009 to March 2014 were studied. Demographics of patients, tumor characteristics, and surgical information were retrospectively collected through medical records. Submucosal invasion was equally categorized into inner one-third (sm1), middle one-third (sm2), and deep one-third (sm3) invasion by pathologists. The patients were observed at the outpatient department in accordance with appointed time and recurrence, and deaths were recorded. The median follow-up duration was 26 months and the deadline was April 2015. Cancer characteristics and its association with LNM and OS were analyzed. RESULTS The study included 75 (29.1%) sm1, 73 (28.3%) sm2, and 110 (42.6%) sm3 patients, and the rates of LNM were 12% (9/75), 11% (8/73), and 20.9% (23/110), respectively. sm3 might be associated with regional LNM (univariate analysis, P=0.041). Tumor volume >1.856 cm(3) (P=0.022) and lymphovascular invasion (LVI) (P=0.004) predicted LNM using multivariate analysis. No significant differences in distant metastases were observed according to the depth of invasion. Only metastatic lymph nodes predicted OS (P<0.001) rather than the depth of invasion. CONCLUSIONS Submucosal ESCC showed a substantial rate of LNM. In T1b ESCC, after adjusting for possible covariates, depth of invasion does not predict LNM or OS.
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Tumour delineation in oesophageal cancer - A prospective study of delineation in PET and CT with and without endoscopically placed clip markers. Radiother Oncol 2015; 116:269-75. [PMID: 26364886 DOI: 10.1016/j.radonc.2015.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/12/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective was to analyse the value of F-18-fluorodesoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) for delineation of the Gross Tumour Volumes (GTVs) in primary radiotherapy of oesophageal cancer. METHOD 20 consecutive and prospective patients (13 men, 7 women) underwent FDG-PET/CT for initial staging and radiation treatment planning. After endoscopy-guided clipping of the tumour another CT study was acquired. The CT and the FDG-PET/CT were registered with a rigid and a non-rigid registration algorithm to compare the overlap between GTV contours defined with the following methods: manual GTV definition in (1) the CT image of the FDG-PET/CT, (2) the PET image of the FDG-PET/CT, (3) the CT study based on endoscopic clips (CT clip), and (4) in the PET-data using different semi-automatic PET segmentation algorithms including a gradient-based algorithm. The absolute tumour volumes, tumour length in cranio-caudal direction, as well as the overlap with the reference volume (CT-clip) were compared for all lesions and separately for proximal/distal tumours. RESULTS In 6 of the patients, FDG-PET/CT discovered previously unknown tumour locations, which resulted in either altered target volumes (n=3) or altered intent of treatment from curative to palliative (n=3) by upstaging to stage IV. For tumour segmentation a large variability between all algorithms was found. For the absolute tumour volumes with CT-clip as reference, no single PET-based segmentation algorithm performed better compared to using the manual CT delineation alone. The best correlation was found between the CT-clip and the gradient based segmentation algorithm (PET-edge, R(2)=0.84) as well as the manual CT-delineation (CT-manual R(2)=0.89). Non-rigid registration between CT and image FDG-PET/CT did not decrease variability between segmentation methods compared to rigid registration statistically significant. For the analysis of tumour length no homogeneous correlation was found. CONCLUSION Whereas FDG-PET was highly relevant for staging purposes, CT imaging with clipping of the tumour extension remains the gold standard for GTV delineation.
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Abstract
GI cancers are a heterogeneous group of neoplasms that differ in their biologic and physical behaviors depending on the organ of origin, location within the organ, and degree of differentiation. As a result, evaluation of these tumors is complex, requiring integration of information from a patient's clinical history, physical examination, laboratory data, and imaging. With advances in anatomic and functional imaging techniques, we now have tools for assessing patients with these tumors at diagnosis, staging, and treatment assessment. It is difficult for a single imaging modality to provide all the necessary information for a given GI tumor. However, well-chosen combinations of available imaging modalities based on the indications, strength, and limitations of the modalities will provide optimal evaluation of patients with these malignancies.
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