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Li Y, Yang L, Gu X, Wang Q, Shi G, Zhang A, Yue M, Wang M, Ren J. Computed tomography radiomics identification of T1-2 and T3-4 stages of esophageal squamous cell carcinoma: two-dimensional or three-dimensional? Abdom Radiol (NY) 2024; 49:288-300. [PMID: 37843576 PMCID: PMC10789855 DOI: 10.1007/s00261-023-04070-1] [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] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND To evaluate two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) radiomics analysis for the T stage of esophageal squamous cell carcinoma (ESCC). METHODS 398 patients with pathologically confirmed ESCC were divided into training and testing sets. All patients underwent chest CT scans preoperatively. For each tumor, based on CT images, a 2D region of interest (ROI) was outlined on the largest cross-sectional area, and a 3D ROI was outlined layer by layer on each section of the tumor. The radiomics platform was used for feature extraction. For feature selection, stepwise logistic regression was used. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of the 2D radiomics model versus the 3D radiomics model. The differences were compared using the DeLong test. The value of the clinical utility of the two radiomics models was evaluated. RESULTS 1595 radiomics features were extracted. After screening, two radiomics models were constructed. In the training set, the difference between the area under the curve (AUC) of the 2D radiomics model (AUC = 0.831) and the 3D radiomics model (AUC = 0.830) was not statistically significant (p = 0.973). In the testing set, the difference between the AUC of the 2D radiomics model (AUC = 0.807) and the 3D radiomics model (AUC = 0.797) was also not statistically significant (p = 0.748). A 2D model was equally useful as a 3D model in clinical situations. CONCLUSION The performance of 2D radiomics model is comparable to that of 3D radiomics model in distinguishing between the T1-2 and T3-4 stages of ESCC. In addition, 2D radiomics model may be a more feasible option due to the shorter time required for segmenting the ROI.
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Affiliation(s)
- Yang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Li Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Xiaolong Gu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China.
| | - Qi Wang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Andu Zhang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Meng Yue
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Mingbo Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Jialiang Ren
- GE Healthcare China, Beijing, 100176, People's Republic of China
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Zhao B, Yan S, Jia ZY, Zhu HT, Shi YJ, Li XT, Qu JR, Sun YS. CT radiomics in the identification of preoperative understaging in patients with clinical stage T1-2N0 esophageal squamous cell carcinoma. Quant Imaging Med Surg 2023; 13:7996-8008. [PMID: 38106287 PMCID: PMC10722054 DOI: 10.21037/qims-23-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/11/2023] [Indexed: 12/19/2023]
Abstract
Background Predicting preoperative understaging in patients with clinical stage T1-2N0 (cT1-2N0) esophageal squamous cell carcinoma (ESCC) is critical to customizing patient treatment. Radiomics analysis can provide additional information that reflects potential biological heterogeneity based on computed tomography (CT) images. However, to the best of our knowledge, no studies have focused on identifying CT radiomics features to predict preoperative understaging in patients with cT1-2N0 ESCC. Thus, we sought to develop a CT-based radiomics model to predict preoperative understaging in patients with cT1-2N0 esophageal cancer, and to explore the value of the model in disease-free survival (DFS) prediction. Methods A total of 196 patients who underwent radical surgery for cT1-2N0 ESCC were retrospectively recruited from two hospitals. Among the 196 patients, 134 from Peking University Cancer Hospital were included in the training cohort, and 62 from Henan Cancer Hospital were included in the external validation cohort. Radiomics features were extracted from patients' CT images. Least absolute shrinkage and selection operator (LASSO) regression was used for feature selection and model construction. A clinical model was also built based on clinical characteristics, and the tumor size [the length, thickness and the thickness-to-length ratio (TLR)] was evaluated on the CT images. A radiomics nomogram was established based on multivariate logistic regression. The diagnostic performance of the models in predicting preoperative understaging was assessed by the area under the receiver operating characteristic curve (AUC). Kaplan-Meier curves with the log-rank test were employed to analyze the correlation between the nomogram and DFS. Results Of the patients, 50.0% (67/134) and 51.6% (32/62) were understaged in the training and validation groups, respectively. The radiomics scores and the TLRs of the tumors were included in the nomogram. The AUCs of the nomogram for predicting preoperative understaging were 0.874 [95% confidence interval (CI): 0.815-0.933] in the training cohort and 0.812 (95% CI: 0.703-0.912) in the external validation cohort. The diagnostic performance of the nomogram was superior to that of the clinical model (P<0.05). The nomogram was an independent predictor of DFS in patients with cT1-2N0 ESCC. Conclusions The proposed CT-based radiomics model could be used to predict preoperative understaging in patients with cT1-2N0 ESCC who have undergone radical surgery.
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Affiliation(s)
- Bo Zhao
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Shuo Yan
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zheng-Yan Jia
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hai-Tao Zhu
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan-Jie Shi
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiao-Ting Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jin-Rong Qu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Ying-Shi Sun
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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Hong Y, Zhong L, Lv X, Liu Q, Fu L, Zhou D, Yu N. Application of spectral CT in diagnosis, classification and prognostic monitoring of gastrointestinal cancers: progress, limitations and prospects. Front Mol Biosci 2023; 10:1284549. [PMID: 37954980 PMCID: PMC10634296 DOI: 10.3389/fmolb.2023.1284549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Gastrointestinal (GI) cancer is the leading cause of cancer-related deaths worldwide. Computed tomography (CT) is an important auxiliary tool for the diagnosis, evaluation, and prognosis prediction of gastrointestinal tumors. Spectral CT is another major CT revolution after spiral CT and multidetector CT. Compared to traditional CT which only provides single-parameter anatomical diagnostic mode imaging, spectral CT can achieve multi-parameter imaging and provide a wealth of image information to optimize disease diagnosis. In recent years, with the rapid development and application of spectral CT, more and more studies on the application of spectral CT in the characterization of GI tumors have been published. For this review, we obtained a substantial volume of literature, focusing on spectral CT imaging of gastrointestinal cancers, including esophageal, stomach, colorectal, liver, and pancreatic cancers. We found that spectral CT can not only accurately stage gastrointestinal tumors before operation but also distinguish benign and malignant GI tumors with improved image quality, and effectively evaluate the therapeutic response and prognosis of the lesions. In addition, this paper also discusses the limitations and prospects of using spectral CT in GI cancer diagnosis and treatment.
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Affiliation(s)
- Yuqin Hong
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Lijuan Zhong
- Department of Radiology, The People’s Hospital of Leshan, Leshan, China
| | - Xue Lv
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Qiao Liu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Langzhou Fu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Daiquan Zhou
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Na Yu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Harino T, Yamasaki M, Murai S, Yamashita K, Tanaka K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Nakajima K, Tomiyama N, Eguchi H, Nakamura H, Doki Y. Impact of MRI on the post-therapeutic diagnosis of T4 esophageal cancer. Esophagus 2023; 20:740-748. [PMID: 37233847 DOI: 10.1007/s10388-023-01010-2] [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: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis. METHODS A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test. RESULTS Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI. CONCLUSIONS Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.
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Affiliation(s)
- Takashi Harino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
| | - Sachiko Murai
- Department of Radiology, Saito Yukokai Hospital, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Haefliger L, Jreige M, Du Pasquier C, Ledoux JB, Wagner D, Mantziari S, Shäfer M, Vietti Violi N, Dromain C. Esophageal cancer T-staging on MRI: A preliminary study using cine and static MR sequences. Eur J Radiol 2023; 166:111001. [PMID: 37516096 DOI: 10.1016/j.ejrad.2023.111001] [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] [Received: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES To evaluate the added value of cine MR in addition to static MRI for T-Staging assessment of esophageal cancer (EC). MATERIALS AND METHODS This prospective monocentric study included 54 patients (mean age 66.3 ± 9.4 years, 46 men) with histologically proven EC. They underwent MRI on a 3 T-scanner in addition to the standard workup. Acquisitions included static and cine sequences (steady-state-free-precession and real-time True-FISP during water ingestion). Three radiologists independently assessed T-staging and diagnosis confidence by reviewing (1) static sequences (S-MRI) and (2) adding cine sequences (SC-MRI). Inter-reader agreement was performed. MRI T-staging was correlated to reference standard T-staging (histopathology or consensus on endoscopic ultrasonography and imaging findings) and to clinical outcome by log-rank test. RESULTS Both S-MRI and SC-MRI T-staging showed a significant correlation with reference T-staging (rs = 0.667, P < 0.001). SC-MRI showed a slightly better performance in distinguishing T1-T3 from T4 with a sensitivity, specificity and AUC of 76.5% (95% CI: 50.1-93.2), 83.8% (68-93.8) and 0.801 (0.681-0.921) vs 70.6% (44-89.7), 83% (68-93.8) and 0.772 (0.645-0.899) for S-MRI. Compared to S-MRI, SC-MRI increased inter-reader agreement for T4a and T4b (κ = 0.403 and 0.498) and T-staging confidence. CONCLUSION MRI is accurate for T-staging of EC. The addition of cine sequences allows better differentiation between T1-T3 and T4 tumors with increased diagnostic confidence and inter-reader agreement.
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Affiliation(s)
- Laura Haefliger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Mario Jreige
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Céline Du Pasquier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Markus Shäfer
- Department of Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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Fujii Y, Daiko H, Kubo K, Kanematsu K, Utsunomiya D, Kurita D, Ishiyama K, Oguma J. Non-curative resection for surgical T4b esophageal cancer: esophagectomy or non-esophagectomy? Langenbecks Arch Surg 2023; 408:201. [PMID: 37209176 DOI: 10.1007/s00423-023-02940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Recently, with the development of multidisciplinary treatment, the treatment outcomes of esophageal cancer (EC) have improved. However, despite advances in diagnostic imaging modalities, preoperative diagnosis of T4 EC is still difficult, and the prognosis of T4 EC remains very poor. In addition, the prognosis of surgical T4b EC (sT4b EC) after surgery remains unclear. In this study, we retrospectively reviewed sT4b EC. METHODS We evaluated the clinical course of sT4b EC and compared palliative esophagectomy with R2 resection (PE group) with other procedures without esophagectomy (NE group) (e.g., only esophagostomy) for sT4b EC. RESULTS Forty-seven patients with thoracic EC underwent R2 resection at our institution between January 2009 and December 2020. Thirty-four patients were in the PE group, and 13 patients were in the NE group. The 2-year overall survival rate was 0% in the PE group and 20.2% in the NE group (p = 0.882). There was one case of long-term survival in the NE group that underwent surgery followed by definitive chemoradiation. Postoperative complications (Clavien-Dindo grade ≥ 3) were observed in 25 patients (73.5%) in the PE group and in three patients (23.1%) in the NE group (p = 0.031). The median time to the initiation of postoperative treatment was 68.1 days in the PE group and 18.6 days in the NE group (p = 0191). CONCLUSIONS If EC is diagnosed as sT4b, palliative esophagectomy should be avoided because of the high complication rate and the lack of long-term survival.
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Affiliation(s)
- Yusuke Fujii
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Gastroenterological Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, Hyogo, 670-8560, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kentaro Kubo
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Kyohei Kanematsu
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Daichi Utsunomiya
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Daisuke Kurita
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Koshiro Ishiyama
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
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Cheng F, Liu Y, Du L, Wang L, Li L, Shi J, Wang X, Zhang J. Evaluation of optimal monoenergetic images acquired by dual-energy CT in the diagnosis of T staging of thoracic esophageal cancer. Insights Imaging 2023; 14:33. [PMID: 36763193 PMCID: PMC9918671 DOI: 10.1186/s13244-023-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES The purpose of our study was to objectively and subjectively assess optimal monoenergetic image (MEI (+)) characteristics from dual-energy CT (DECT) and the diagnostic performance for the T staging in patients with thoracic esophageal cancer (EC). METHODS In this retrospective study, patients with histopathologically confirmed EC who underwent DECT from September 2019 to December 2020 were enrolled. One standard polyenergetic image (PEI) and five MEI (+) were reconstructed. Two readers independently assessed the lesion conspicuity subjectively and calculated the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) of EC. Two readers independently assessed the T stage on the optimal MEI (+) and PEI subjectively. Multiple quantitative parameters were measured to assess the diagnostic performance to identify T1-2 from T3-4 in EC patients. RESULTS The study included 68 patients. Subjectively, primary tumor delineation received the highest ratings in MEI (+) 40 keV of the venous phase. Objectively, MEI (+) images showed significantly higher SNR compared with PEI (p < 0.05), peaking at MEI (+) 40 keV in the venous phase. CNR of tumor (MEI (+) 40 keV -80 keV) was all significantly higher than PEI in arterial and venous phases (p < 0.05), peaking at MEI (+) 40 keV in venous phases. The agreement between MEI (+) 40 keV and pathologic T categories was 81.63% (40/49). Rho values in venous phases had excellent diagnostic efficiency for identifying T1-2 from T3-4 (AUC = 0.84). CONCLUSIONS MEI (+) reconstructions at low keV in the venous phase improved the assessment of lesion conspicuity and also have great potential for preoperative assessment of T staging in patients with EC.
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Affiliation(s)
- Fanrong Cheng
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China ,People’s Hospital of Rongchang District, Chongqing, 402460 China
| | - Yan Liu
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Lihong Du
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Lei Wang
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Lan Li
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Jinfang Shi
- grid.190737.b0000 0001 0154 0904Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Xiaoxia Wang
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, China.
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Risk Factors for Tumor Positive Resection Margins After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: Results From the Dutch Upper GI Cancer Audit: A Nationwide Population-Based Study. Ann Surg 2023; 277:e313-e319. [PMID: 34334634 PMCID: PMC9831046 DOI: 10.1097/sla.0000000000005112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify risk factors for tumor positive resection margins after neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal cancer. SUMMARY BACKGROUND DATA Esophagectomy after nCRT is associated with tumor positive resection margins in 4% to 9% of patients. This study evaluates potential risk factors for positive resection margins after nCRT followed by esophagectomy. METHODS All patients who underwent an elective esophagectomy following nCRT in 2011 to 2017 in the Netherlands were included. A multivariable logistic regression was performed to assess the association between potential risk factors and tumor positive resection margins. RESULTS In total, 3900 patients were included. Tumor positive resection margins were observed in 150 (4%) patients. Risk factors for tumor positive resection margins included tumor length (in centimeters, OR: 1.1, 95% CI: 1.0-1.1), cT4-stage (OR: 3.0, 95% CI: 1.2-6.7), and an Ivor Lewis esophagectomy (OR: 1.6, 95% CI: 1.0-2.6). Predictors associated with a lower risk of tumor positive resection margins were squamous cell carcinoma (OR: 0.4, 95% CI: 0.2-0.7), distal tumors (OR: 0.5, 95% CI: 0.3-1.0), minimally invasive surgery (OR: 0.6, 95% CI: 0.4-0.9), and a hospital volume of >60 esophagectomies per year (OR: 0.6, 95% CI: 0.4-1.0). CONCLUSIONS In this nationwide cohort study, tumor and surgical related factors (tumor length, histology, cT-stage, tumor location, surgical procedure, surgical approach, hospital volume) were identified as risk factors for tumor positive resection margins after nCRT for esophageal cancer. These results can be used to improve the radical resection rate by careful selection of patients and surgical approach and are a plea for centralization of esophageal cancer care.
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Aorta and tracheobronchial invasion in esophageal cancer: comparing diagnostic performance of 3.0-T MRI and CT. Eur Radiol 2023:10.1007/s00330-023-09425-2. [PMID: 36692595 DOI: 10.1007/s00330-023-09425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/11/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare between the diagnostic performance of 3.0-T MRI and CT for aorta and tracheobronchial invasion in patients with esophageal cancer (EC). METHODS We prospectively included patients with pathologically confirmed EC from November 2018 to June 2021, who had baseline stage of T3-4N0-2M0 and restaging after neoadjuvant chemotherapy. All patients underwent contrast-enhanced CT and MRI of the thorax. Two independent blinded radiologists scored image quality and the presence of invasion. Agreements between the two readers were calculated using kappa test. The sensitivity, specificity, accuracy, positive predict value (PPV), and negative predict value (NPV) of MRI and CT in evaluating invasion were calculated. The net reclassification index (NRI) was used to evaluate the change in the number of patients correctly classified by MRI and CT. RESULTS A total of 70 patients (64.8 ± 9.0 years; 53 men) were enrolled. Inter-reader agreements of image quality scores and presence of invasion by MRI and CT between the two readers were almost perfect (kappa > 0.80). The accuracy of MRI in evaluating thoracic aorta invasion was significantly higher than that of CT (reader 1: 90.0% vs. 71.4%; reader 2: 92.9% vs. 70.0%, respectively), and the accuracy of MRI in evaluating tracheobronchial invasion also was significantly higher than that of CT (reader 1: 92.9% vs. 72.9%; reader 2: 95.7% vs. 70.0%, respectively). NRI values were positive in both the evaluation of aorta and tracheobronchial invasion. CONCLUSIONS The accuracy of 3-T MRI in determining thoracic aorta and tracheobronchial invasion is significantly higher than that of CT. KEY POINTS • 3.0-T MRI was significantly more accurate than CT in assessing invasion of the thoracic aorta in patients with esophageal cancer. • 3.0-T MRI was also significantly more accurate than CT in assessing tracheobronchial invasion in patients with esophageal cancer. • 3.0-T MRI has a higher diagnostic performance than CT in evaluating patients with suspected aortic or tracheobronchial invasion in esophageal cancer.
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Xing X, Kuang X, Li X, Cheng Y, Liu F. Potential use of high-resolution T2-weighted MRI with histopathologic findings in staging esophageal cancer. Quant Imaging Med Surg 2023; 13:249-258. [PMID: 36620170 PMCID: PMC9816713 DOI: 10.21037/qims-22-376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
Background Magnetic resonance imaging (MRI) has shown promising capabilities in diagnosing local esophageal carcinoma. This study investigated the clinical value of high resolution (HR; small field of view and continuous thin section) axial T2-weighted MRI (HR-T2WI) as a noninvasive method for esophageal carcinoma tumor staging (T staging). Methods Forty-two patients with biopsy-proven esophageal cancer were investigated using HR-T2WI. The discrepancies between the esophageal wall layers and tumor tissue were assessed for MRI T staging using a visual MRI signal intensity scale (low, intermediate, and high intensities). The computed tomography (CT) and MRI T staging was compared with whole-mount histopathological sections in all patients who underwent resection. Results HR-T2WI provided a thorough view of the esophageal wall and the tumor's anatomic layers. Of the 42 patients with histological tumors (HTs), there were 6 cases with tumors classified as HT-1a, 5 cases with HT-1b, 14 cases with HT-2, and 17 cases with HT-3/4, and their MRI T stages were 5 MRI-T1a, 6 MRI-T1b, 14 MRI-T2, and 17 MRI-T3/4, respectively. After analyzing the imaging presentation at different HT staginess, we found that HR-T2WI enabled a more accurate classification than was possible with CT. The difference in accuracy between CT and T2WI was statistically significant (P<0.05) in the entire sample and in HT1-2 tumors and HT3-4 tumors. Conclusions HR-T2WI clearly identified normal esophageal wall layers; it had high diagnostic accuracy when evaluating tumor invasion and in MRI-T staging for esophageal carcinoma. This study established staging criteria of esophageal carcinoma using HR-T2WI and indicated that this approach could be used as a supplemental noninvasive method for the local T staging of esophageal carcinoma.
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Affiliation(s)
- Xiaohong Xing
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, China
| | - Xiaochun Kuang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, China
| | - Xiaobing Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai, China;,Department of Radiology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fengjun Liu
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai Fudan University, Shanghai, China
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11
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Withey SJ, Goh V, Foley KG. State-of-the-art imaging in oesophago-gastric cancer. Br J Radiol 2022; 95:20220410. [PMID: 35671095 PMCID: PMC10996959 DOI: 10.1259/bjr.20220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Radiological investigations are essential in the management of oesophageal and gastro-oesophageal junction cancers. The current multimodal combination of CT, 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET/CT) and endoscopic ultrasound (EUS) has limitations, which hinders the prognostic and predictive information that can be used to guide optimum treatment decisions. Therefore, the development of improved imaging techniques is vital to improve patient management. This review describes the current evidence for state-of-the-art imaging techniques in oesophago-gastric cancer including high resolution MRI, diffusion-weighted MRI, dynamic contrast-enhanced MRI, whole-body MRI, perfusion CT, novel PET tracers, and integrated PET/MRI. These novel imaging techniques may help clinicians improve the diagnosis, staging, treatment planning, and response assessment of oesophago-gastric cancer.
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Affiliation(s)
- Samuel J Withey
- Department of Radiology, The Royal Marsden NHS Foundation
Trust, London,
UK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging
Sciences, King’s College London,
London, UK
- Department of Radiology, Guy’s and St Thomas’ NHS
Foundation Trust, London,
UK
| | - Kieran G Foley
- Division of Cancer & Genetics, School of Medicine, Cardiff
University, Wales,
UK
- Department of Radiology, Velindre Cancer Centre,
Cardiff, UK
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12
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Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, van Hooft JE, Deprez PH, Dinis-Ribeiro M. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54:591-622. [PMID: 35523224 DOI: 10.1055/a-1811-7025] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett's esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.
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Affiliation(s)
- Pedro Pimentel-Nunes
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Surgery and Physiology, Porto Faculty of Medicine, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, The Netherlands
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia and Western Clinical School, University of Sydney, Sydney, Australia
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Radlinski M, Shami VM. Role of endoscopic ultrasound in esophageal cancer. World J Gastrointest Endosc 2022; 14:205-214. [PMID: 35634483 PMCID: PMC9048493 DOI: 10.4253/wjge.v14.i4.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer (ECA) affects 1 in 125 men and 1 in 417 for women and accounts for 2.6% of all cancer related deaths in the United States. The associated survival rate depends on the stage of the cancer at the time of diagnosis, making adequate work up and staging imperative. The 5-year survival rate for localized disease is 46.4%, regional disease is 25.6%, and distant/metastatic disease is 5.2%. Additionally, treatment is stage-dependent, making staging all that much important. For nonmetastatic transmural tumors (T3) and/or those that have locoregional lymph node involvement (N), neoadjuvant therapy is recommended. Conversely, for those who have earlier tumors, upfront surgical resection is reasonable. While positron emission tomography/computed tomography and other cross sectional imaging modalities are exceptional for detecting distant disease, they are inaccurate in staging locoregional disease. Endoscopic ultrasound (EUS) has played a key role in the locoregional (T and N) staging of newly diagnosed ECA and has an evolving role in restaging after neoadjuvant therapy. There is even data to support that the use of EUS facilitates proper triaging of patients and may ultimately save money by avoiding unnecessary or futile treatment. This manuscript will review the current role of EUS on staging and restaging of ECA.
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Affiliation(s)
- Mark Radlinski
- Internal Medicine, University of Virginia, Charlottesville, VA 22901, United States
| | - Vanessa M Shami
- Digestive Health Center, University of Virginia Health System, Charlottesville, VA 22901, United States
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14
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Chen W, Wang Y, Bai G, Hu C. Can Lymphovascular Invasion be Predicted by Preoperative Contrast-Enhanced CT in Esophageal Squamous Cell Carcinoma? Technol Cancer Res Treat 2022; 21:15330338221111229. [PMID: 35790460 PMCID: PMC9340382 DOI: 10.1177/15330338221111229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To explore whether preoperative contrast-enhanced
computed tomogrpahy (CT) can predict lymphovascular invasion (LVI) in esophageal
squamous cell carcinoma (ESCC), and provide a reliable reference for the
formulation of clinical individualized treatment plans. Methods:
This retrospective study enrolled 228 patients with surgically resected and
pathologically confirmed ESCC, including 36 patients with LVI and 192 patients
without LVI. All patients underwent contrast-enhanced CT (CECT) scan within 2
weeks before the operation. Tumor size (including tumor length and maximum tumor
thickness), tumor-to-normal wall enhancement ratio (TNR), and gross tumor volume
(GTV) were obtained. All clinical features and CECT-derived parameters
associated with LVI were analyzed by univariate and multivariate analysis. The
independent predictors for LVI were identified, and their combination was built
by multivariate logistic regression analysis, using the significant variables
from the univariate analysis as inputs. Results: Univariate
analysis of clinical features and CECT-derived parameters revealed that age,
TNR, and clinical N stage (cN stage) were significantly associated with LVI. The
multivariable analysis results demonstrated that age (odds ratio [OR]: 5.32, 95%
confidence interval [CI]: 2.224-12.743, P<.001), TNR (OR:
5.399, 95% CI: 1.609-18.110, P = .006), and cN stage (cN1:
OR: 2.874, 95% CI: 1.182-6.989, P = .02; cN2: OR: 6.876, 95%
CI: 2.222-21.227) were identified to be independent predictors for LVI. The
combination of age, TNR, and cN stage achieved a relatively higher area under
the curve (AUC) (0.798), accuracy (ACC) (65.4%), sensitivity (SEN) (69.4%),
specificity (SPE) (79.7%), positive predictive value (PPV) (77.4%), and negative
predictive value (NPV) (71.6%). Conclusions: The combination of
clinical features and CECT-derived parameters may be effective in predicting LVI
status preoperatively in ESCC.
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Affiliation(s)
- Wei Chen
- The First Affiliated Hospital of Soochow
University, Suzhou, Jiangsu, China
| | - Yating Wang
- The Affiliated Huai’an No. 1 People’s
Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Genji Bai
- The Affiliated Huai’an No. 1 People’s
Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Chunhong Hu
- The First Affiliated Hospital of Soochow
University, Suzhou, Jiangsu, China
- Chunhong Hu, Department of Radiology, The
First Affiliated Hospital of Soochow University, No. 188 Ten Catalpa Street,
Suzhou, Jiangsu 215006, China.
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15
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Lazzaro RS, Inra ML. Commentary: Nomogram to the rescue: Validate and show me the money. J Thorac Cardiovasc Surg 2021; 164:276-277. [PMID: 34815092 DOI: 10.1016/j.jtcvs.2021.10.037] [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: 10/24/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Richard S Lazzaro
- Department of Cardiovascular and Thoracic Surgery, Northwell Health Lenox Hill Hospital, New York, NY; Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY.
| | - Matthew L Inra
- Department of Cardiovascular and Thoracic Surgery, Northwell Health Lenox Hill Hospital, New York, NY; Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY
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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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17
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Li Y, Yu M, Wang G, Yang L, Ma C, Wang M, Yue M, Cong M, Ren J, Shi G. Contrast-Enhanced CT-Based Radiomics Analysis in Predicting Lymphovascular Invasion in Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:644165. [PMID: 34055613 PMCID: PMC8162215 DOI: 10.3389/fonc.2021.644165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/08/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives To develop a radiomics model based on contrast-enhanced CT (CECT) to predict the lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC) and provide decision-making support for clinicians. Patients and Methods This retrospective study enrolled 334 patients with surgically resected and pathologically confirmed ESCC, including 96 patients with LVI and 238 patients without LVI. All enrolled patients were randomly divided into a training cohort and a testing cohort at a ratio of 7:3, with the training cohort containing 234 patients (68 patients with LVI and 166 without LVI) and the testing cohort containing 100 patients (28 patients with LVI and 72 without LVI). All patients underwent preoperative CECT scans within 2 weeks before operation. Quantitative radiomics features were extracted from CECT images, and the least absolute shrinkage and selection operator (LASSO) method was applied to select radiomics features. Logistic regression (Logistic), support vector machine (SVM), and decision tree (Tree) methods were separately used to establish radiomics models to predict the LVI status in ESCC, and the best model was selected to calculate Radscore, which combined with two clinical CT predictors to build a combined model. The clinical model was also developed by using logistic regression. The receiver characteristic curve (ROC) and decision curve (DCA) analysis were used to evaluate the model performance in predicting the LVI status in ESCC. Results In the radiomics model, Sphericity and gray-level non-uniformity (GLNU) were the most significant radiomics features for predicting LVI. In the clinical model, the maximum tumor thickness based on CECT (cThick) in patients with LVI was significantly greater than that in patients without LVI (P<0.001). Patients with LVI had higher clinical N stage based on CECT (cN stage) than patients without LVI (P<0.001). The ROC analysis showed that both the radiomics model (AUC values were 0.847 and 0.826 in the training and testing cohort, respectively) and the combined model (0.876 and 0.867, respectively) performed better than the clinical model (0.775 and 0.798, respectively), with the combined model exhibiting the best performance. Conclusions The combined model incorporating radiomics features and clinical CT predictors may potentially predict the LVI status in ESCC and provide support for clinical treatment decisions.
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Affiliation(s)
- Yang Li
- Department of Computed Tomography and Magnetic Resonance, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng Yu
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guangda Wang
- Department of Computed Tomography and Magnetic Resonance, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li Yang
- Department of Computed Tomography and Magnetic Resonance, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chongfei Ma
- Department of Computed Tomography and Magnetic Resonance, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingbo Wang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng Yue
- Department of Pathology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengdi Cong
- Department of Computed Tomography and Magnetic Resonance, Children's Hospital of Hebei Province, Shijiazhuang, China
| | | | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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