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

Abstract

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