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Abstract
The management of patients with esophageal carcinoma (EC) requires accurate clinical staging and post-therapeutic evaluation. Currently, esophagogastroduodenoscopy/endoscopic ultrasound (EGD/EUS), endoscopic ultrasound-fine needle aspiration (EUS-FNA), computed tomography (CT), 18F- fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance (MR) imaging are used for the initial clinical staging, evaluation of therapeutic response and follow-up in patients with EC. However, there are limitations and pitfalls that are commonly encountered when imaging these patients that can limit accurate assessment. Knowledge of the limitations and pitfalls associated with the use of these different imaging modalities is essential in avoiding misinterpretation and guaranteeing the appropriate management for patient with EC.
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Affiliation(s)
| | - Diana P Palacio
- Department of Medical Imaging, The University of Arizona- Banner Medical Center, Tucson, AZ
| | | | - Yasmeen Mawlawi
- Thoracic Imaging Department, The University of Texas, M.D, Anderson Cancer Center, Houston, TX
| | - Jeremy J Erasmus
- Thoracic Imaging Department, The University of Texas, M.D, Anderson Cancer Center, Houston, TX
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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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Betancourt Cuellar SL, Palacio DP, Benveniste MF, Carter BW, Hofstetter WL, Marom EM. Positron Emission Tomography/Computed Tomography in Esophageal Carcinoma: Applications and Limitations. Semin Ultrasound CT MR 2017; 38:571-583. [PMID: 29179897 DOI: 10.1053/j.sult.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Squamous cell carcinoma and adenocarcinoma represent approximately 98% of esophageal malignant tumors. During the last 30 years, the incidence of adenocarcinoma has increased in Western countries (including the USA) where adenocarcinoma currently represents more than 60% of esophageal malignancies, although, worldwide, squamous cell carcinoma continues to be the predominant histologic type. Integrated positron emission tomography or computed tomography with 2-[fluorine18] fluro-2-deoxy-d-glucose is used in many institutions routinely as a tool in the initial staging and then repeated after therapy for the assessment of response to neoadjuvant therapy and detection of recurrent disease in patients with esophageal carcinoma. As with any other imaging modality, 2-[fluorine18] fluro-2-deoxy-d-glucose-positron emission tomography or computed tomography has strengths and limitations that should be understood in order to maximize its utility.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Address reprint request to Sonia L. Betancourt Cuellar, MD, Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030..
| | - Diana P Palacio
- Department of Diagnostic Radiology, University of Arizona, Medical Center, Tucson, AZ
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated with the Tel Aviv University, Israel
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Betancourt Cuellar SL, Heller L, Palacio DP, Hofstetter WL, Marom EM. Intra- and Extra-Thoracic Muscle Flaps and Chest Wall Reconstruction Following Resection of Thoracic Tumors. Semin Ultrasound CT MR 2017; 38:604-615. [PMID: 29179900 DOI: 10.1053/j.sult.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improvements in surgical technique over the last decade enable surgeons to perform extensive resection and reconstruction in patients presenting with tumors involving the soft tissue or bony structures of the chest wall. The type of surgical resection and its size, depend on the type of tumor resected and its location. In addition to providing a better esthetic result, the reconstruction restores support and functionality of the thoracic cage. The approach to chest wall repair includes primary closure or reconstruction by using transposition flaps, free flaps, prosthetic material, or a mixture of a flap and prosthetic material.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Address reprint requests to Sonia L. Betancourt Cuellar, MD, Diagnostic Radiology Department, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Diana P Palacio
- Department of Diagnostic Radiology, University of Arizona, Medical Center, Tucson, AZ
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated with the Tel Aviv University, Israel
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Betancourt Cuellar SL, Palacio DP, Wu CC, Carter BW, Correa AM, Hofstetter WL, Marom EM. 18FDG-PET/CT is useful in the follow-up of surgically treated patients with oesophageal adenocarcinoma. Br J Radiol 2017; 91:20170341. [PMID: 29125331 DOI: 10.1259/bjr.20170341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate fludeoxyglucose-positron emission ;tomography/CT's (FDG-PET/CT) performance in the follow ;up of patients with surgically treated oesophageal adenocarcinoma. METHODS The follow-up FDG-PET/CT scans of 162 consecutive patients with surgically treated oesophageal adenocarcinoma were retrospectively reviewed. Histopathological and/or imaging examinations confirmed recurrent disease. The accuracy, sensitivity, specificity and negative and positive predictive values were calculated. RESULTS Recurrence occurred in 71 (43%) patients, usually within the first year following surgery (60%) and in more than one site (76%). The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of FDG-PET/CT for anastomotic recurrence were 77, 76, 16, 98 and 76%; for regional nodal recurrence were 88, 85, 43, 97 and 86%; and for distant metastatic recurrence were: 97, 96, 91, 99 and 96%. In 5 of the 42 patients (12%) with distant metastases, the metastatic sites were outside the area covered by a conventional follow-up chest-abdomen CT and in 4 patients (9%) metastases were barely perceptible on the CT component of the FDG-PET/CT and consequently were unlikely to be detected without the aid of the FDG uptake. CONCLUSION FDG PET/CT is accurate in detecting oesophageal adenocarcinoma recurrence, especially within the first post-operative year when most recurrences occur, and is useful in identifying patients with a solitary metastasis. Advances in knowledge: FDG-PET/CT should be considered as a valuable tool in the routine follow ;up of surgically treated oesophageal cancer patients within the first 2 years after surgery.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Diana P Palacio
- 2 Department of Diagnostic Radiology,University of Arizona, Medical Center , University of Arizona, Medical Center , Chicago, IL , USA
| | - Carol C Wu
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Brett W Carter
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Arlene M Correa
- 3 Department of Thoracic & Cardio Surgery-Rsch,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Wayne L Hofstetter
- 4 Department of Thoracic & Cardiovasc Surgery,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Edith M Marom
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA.,5 Department Diagnostic Imaging,The Chaim Sheba Medical Center, Tel Aviv University , The Chaim Sheba Medical Center, Tel Aviv University , Ramat-Gan , Israel
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