Staging Of Esophageal Cancer Research Articles

Lymph node ratio evaluation precisely predicts the benefit of postoperative radiotherapy in esophageal cancer: A retrospective cohort study.

The matter of postoperative radiotherapy (PORT) in esophageal cancer (ESCA) was far from conclusive. Some evidence indicated that lymph node status could affect treatment. We evaluated lymph node ratio (LNR) as an indicator that could be applied to predict PORT benefit. Retrospective cohort study collected the data of N1, N2, N3 stage ESCA patients from the Surveillance, Epidemiology, and End Results database (SEER) to analyze the association between LNR and prognosis from 2004 to 2015. Patients were categorized into two subsets based on the LNR cut-off value of 0.23 using receiver operating characteristic curve (ROC). Kaplan-Meier analysis was utilized to estimate the proportion of overall survival (OS) and esophagus cancer-specific survival (CSS) in two LNR groups. Cox regression analysis and competitive risk model was adopted to investigate the impacts of LNR on prognosis. Of 2,165 ESCA patients identified, 1,165 (53.8%) had LNR>0.23. The LNR was an independent prognostic factor and associated with better OS and CSS of LNR≤0.23 (P<0.001). In competitive risk model, a worse CSS was analyzed of LNR>0.23 (HR=1.71; 95% CI 1.53-1.91). Subgroup analyses indicated that PORT was associated with favorable OS and CSS. Furthermore, when stratified by Node stage, PORT was associated with a survival benefit only in N1 stage with higher LNR (LNR>0.23) after adjusting for other covariates. LNR exceeding 0.23 was negatively associated with prognosis in ESCA. The survival benefit from PORT in ESCA seems to be limited to LNR of 23% or more only in N1 stage. This study highlights the biomarker meaning of LNR on identifying PORT beneficiary in N1 stage.

Forecasting the “T” Stage of Esophageal Cancer by Deep Learning Methods: A Pilot Study

Research motivation: Staging esophageal cancer is of paramount importance for treatment. With conventional methods, accuracy of staging is low, we aimed to improve the accuracy of the “T” stage of esophageal cancer by using deep learning techniques. Method/Material: Clinically diagnosed esophageal cancer patients were prospectively observed and their data were collected. jpeg images were collected from the Computed Tomography of patients. 80% of the data were used for training and 20% for tests. Pathology results were used as the gold standard in the training of deep learning algorithms. EfficientNetB7 and ResNet152V2 models were used in the study. Both architectures with convolutional neural networks have Convolutional layers, pool layers, and fully connected layers. Results: A total of 477 images of 50 patients were analyzed. EfficientNetB7 makes predictions with a total of 64,107,931 parameters, and ResNet152V2 58,339,844 parameters within seconds (2[Formula: see text]s) at rates close to the accuracy offered by humans. With the EfficientNetB7 architecture, one of the Convolutional Neural Networks used in this study, 90% accuracy was achieved in the “T” staging of esophageal cancer. Conclusion: Despite the very limited dataset, deep learning algorithms can perform effective and reliable staging under the supervision of an experienced radiologist. With more datasets, the precision of the estimation can increase.

Neoadjuvant and adjuvant therapy in esophageal cancer.

Esophageal cancer is an aggressive malignancy that carries a high mortality rate. The treatment of locally advanced resectable esophageal cancer requires a multimodal approach involving chemotherapy, radiation therapy, and surgical resection. Optimal treatment combinations and sequences for squamous cell carcinoma (SCC) versus adenocarcinoma (AC) histological subtypes are still being determined. For very early stage esophageal cancers, endoscopic therapies or surgical resection without chemotherapy and radiation are preferred. Neoadjuvant chemoradiation followed by surgical resection has been the standard in locally advanced resectable esophageal cancer based on the landmark CROSS trial. Definitive chemoradiation is recommended for patients who are not surgical candidates or decline surgery. Perioperative chemotherapy without radiation can be considered for lower esophageal AC and gastroesophageal (GE)-junction AC based on landmark MAGIC and FLOT4 trials. Additional trials are underway to compare preoperative chemoradiation to perioperative chemotherapy in esophageal and GE-junction ACs. Thus far, targeted therapies against vascular endothelial growth factor (VEGF) and human epidermal growth factor receptor 2 (HER2) have not been successful in the neoadjuvant/adjuvant setting. The roll of immunotherapy in perioperative/adjuvant setting is promising. Based on the CheckMate 577 trial, adjuvant nivolumab should be considered for all patients following neoadjuvant chemoradiation and R0 resection with residual pathologic disease. Additional trials involving various immunotherapy agents are underway.

Systematic meta-analysis of computer-aided detection to detect early esophageal cancer using hyperspectral imaging.

One of the leading causes of cancer deaths is esophageal cancer (EC) because identifying it in early stage is challenging. Computer-aided diagnosis (CAD) could detect the early stages of EC have been developed in recent years. Therefore, in this study, complete meta-analysis of selected studies that only uses hyperspectral imaging to detect EC is evaluated in terms of their diagnostic test accuracy (DTA). Eight studies are chosen based on the Quadas-2 tool results for systematic DTA analysis, and each of the methods developed in these studies is classified based on the nationality of the data, artificial intelligence, the type of image, the type of cancer detected, and the year of publishing. Deeks' funnel plot, forest plot, and accuracy charts were made. The methods studied in these articles show the automatic diagnosis of EC has a high accuracy, but external validation, which is a prerequisite for real-time clinical applications, is lacking.

Quality and consistency of clinical practice guideline recommendations for PET/CT and PET: a systematic appraisal.

To systematically appraise the methodologies used for guidelines for positron emission tomography (PET) imaging and to compare the consistency of these recommendations. We searched PubMed, EMBASE, four guideline databases, and Google Scholar to identify evidence-based clinical practice guidelines pertaining to the use of PET, PET/computed tomography (CT), or PET/magnetic resonance in routine practice. We assessed the quality of each guideline using the Appraisal of Guidelines for Research and Evaluation II instrument and compared recommendations regarding indications for 18F-fluorodeoxyglucose (FDG) PET/CT. Thirty-five guidelines for PET imaging, published between 2008 and 2021, were included. These guidelines performed well in the domains of scope and purpose (median 80.6%, inter-quartile range [IQR] 77.8-83.3%) and clarity of presentation (median 75%, IQR 69.4-83.3%), but poorly in applicability (median 27.1%, IQR 22.9-37.5%). Recommendations for 48 indications in 13 cancers were compared. Considerable inconsistencies in the direction of whether to support the use of FDG PET/CT were observed in 10 (20.1%) indications pertaining to 8 cancer types: head and neck cancer (treatment response assessment), colorectal cancer (staging in patients with stages I-III disease), esophageal cancer (staging), breast cancer (restaging and treatment response assessment), cervical cancer (staging in patients with stage < IB2 disease and treatment response assessment), ovarian cancer (restaging), pancreatic cancer (diagnosis), and sarcoma (treatment response assessment). Current guidelines for PET imaging vary in methodological quality and provided considerably inconsistent recommendations. Efforts are needed to improve adherence to guideline development methodologies, to synthesis high-quality evidence, and to adopt standard terminologies. PROSPERO CRD42020184965. Guidelines for PET imaging provide considerably inconsistent recommendations and vary in methodological quality. It is suggested that clinicians be critical of these recommendations when applying them in practice, that guideline developers adopt more rigorous development methodologies, and that researchers prioritize research gaps identified by current guidelines. • PET guidelines vary in methodological quality and provided inconsistent recommendations. Efforts are needed to improve methodologies, synthesize high-quality evidence, and standardize terminologies. • Among six domains of methodological quality assessed by the AGREE II tool, guidelines for PET imaging performed well in scope and purpose (median 80.6%, inter-quartile range 77.8-83.3%) and clarity of presentation (75%, 69.4-83.3%), but poorly in applicability (27.1%, 22.9-37.5%). • Among the 48 recommendations (for 13 cancer types) compared, conflicts in the direction of whether to support FDG PET/CT use were observed in 10 (20.1%), for 8 cancer types (i.e., head and neck, colorectal, esophageal, breast, cervical, ovarian, pancreatic, and sarcoma).

Comparison of efficacy and safety of neoadjuvant regimens for resectable esophageal squamous cell carcinoma: A meta-analysis.

e16098 Background: Recent studies have demonstrated that preoperative neoadjuvant therapy in esophageal carcinoma can bring extra survival benefits compared to surgical resection alone or postoperative adjuvant therapy. There is still a lack of high-level evidence from large randomized controlled clinical trials to define the interval between neoadjuvant therapy and surgery, radiotherapy dose and target area plans after neoadjuvant treatment, therefore we adopted a meta-analysis to compare the efficacy and safety of different neoadjuvant treatment options in esophageal squamous cell carcinoma (ESCC) in these clinical studies. Methods: Articles were retrieved from PubMed, Cochrane, Embase, Web of Science databases and abstracts of ASCO and ESMO meetings in 2021-2022 by the terms esophageal cancer, neoadjuvant therapy, Inclusion criteria: a: Patients with excisable stage esophageal cancer. Histopathological confirmed squamous carcinoma of the esophagus; b: At least one reported primary outcome as follows: pathological complete response (pCR) rate; major pathological response (MPR) rate. Statistical analysis was performed on Stata 16.0 and R 4.0 with a significance level of 0.05. Results: A total of 39 clinical studies with a total of 2,434 patients, mostly male, were included, with a predominance of phase 2 trials. 16 neoadjuvant chemotherapy combined with immunotherapy (nICT), 2 neoadjuvant immunotherapy alone, 5 neoadjuvant chemoradiotherapy combined with immunotherapy (nICRT), 15 neoadjuvant chemoradiotherapy (nCRT), 1 neoadjuvant chemotherapy, 32 single-arm studies, and 7 randomized controlled trials. The overall neoadjuvant therapy pCR rate was 36% (95% CI: 32%-40%) and the overall MPR rate was 55% (95% CI: 47%-63%). The nICT pathological complete response rate was 31% (95% CI: 26%-36%), nCRT pathological complete response rate was 38% (95% CI: 32%-44%) and nICRT complete pathological response rate was 49% (95% CI: 39% -59%). Complete pathological response rates were 36% (95% CI: 31%-41%) for neoadjuvant immunotherapy (with immunotherapy) and 33% (95% CI: 13%-54%) for neoadjuvant immunotherapy alone. 26 studies had a mean R0 resection rate of 93%, with the majority of patients achieving R0 resection. Conclusions: From this Meta-analysis it can be concluded that nICRT has the best complete pathological response rate of all neoadjuvant treatments and nCRT has a better complete pathological reponse rate than nICT, but most of them are not phase 3 clinical trials, therefore more studies are needed to further clarify the benefit of neoadjuvant radiotherapy combined with immunotherapy in esophageal squamous cell carcinoma.

Mapping of Lymph Node Metastasis and Efficacy Index in Thoracic Esophageal Squamous Cell Carcinoma: A Large-Scale Retrospective Analysis.

Esophageal squamous cell carcinoma has a high mortality rate in China. The metastatic pattern in the lymph nodes and the value of their dissection on the overall survival of these patients remain controversial. The primary aim of this study was to provide a basis for accurate staging of esophageal cancer and to identify the relationship between esophageal cancer surgery, lymph node dissection, and overall survival rates. We utilized our hospital database to retrospectively review the data of 1727 patients with esophageal cancer who underwent R0 esophagectomy from January 2010 to December 2017. The lymph nodes were defined according to Japanese Classification of Esophageal Cancer, 11th Edition. The Efficacy Index (EI) was calculated by multiplying the frequency (%) of metastases to a zone and the 5-year survival rate (%) of patients with metastases to that zone, and then dividing by 100. The EI was high in the supraclavicular and mediastinal zones in patients with upper esophageal tumors, and the EI of 101R was 17.39, which was the highest among the lymph node stations. In patients with middle esophageal tumors, the EI was highest in the mediastinal zone, followed by the celiac and supraclavicular zones. Furthermore, the EI was highest in the celiac zone, followed by the mediastinal zones in patients with lower esophageal tumors. The EI of resected lymph nodes was found to vary between stations and was related to the primary location of the tumor.

Staging Accuracy and Lymph Node Involvement in Superficial Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus—a Multicenter Case Series Analysis

AbstractAt an early stage, esophageal cancer can be removed surgically or endoscopically. T1a tumors are removed by endoscopic resection, whereas T1b tumors are preferably surgically removed (esophagectomy) due to possible lymph node involvement. However, the diagnostic tools (endoscopic ultrasonography (EUS) and CT/PET-CT) used to distinguish between T1a and T1b tumors and to detect malignant lymph nodes are imprecise. This study aimed to review the accuracy of preoperative locoregional staging in superficial esophageal cancer in a Danish setting. This was a retrospective, multicenter study including patients with a cT1 esophageal tumor, both adenocarcinoma and squamous cell carcinoma. Patients receiving neoadjuvant treatment were excluded. Results from the preoperative diagnostics tools were compared with the pathology report to determine the diagnostic accuracy. Sixty-eight patients were included, 34 patients underwent esophagectomy, and 34 patients underwent endoscopic resection. The positive predictive value (PPV) of PET-CT (or CT) (when staged as a T1 tumor) was 77% (95%CI: 0.59–0.88), and the PPV of EUS (when staged as a T1a or T1b tumor) was 52% (95%CI: 0.32–0.72) and 60% (95%CI: 0.36–0.82), respectively. Six patients had malignant lymph nodes in the surgical specimen; none of them was identified before surgery. In conclusion, neither CT/PET-CT nor EUS is a precise tool to distinguish mucosal from submucosal esophageal tumors. Furthermore, in superficial malignant lesions, lymph node involvement is rare, but when present, it is rarely detected before surgery. To improve staging accuracy, all patients with cT1 tumors could be referred for a diagnostic endoscopic resection prior to possible other treatments.

Esophageal Cancer Complicated by an Oesobronchial Fistula Revealed by a Pulmonary Abscess: About One Case

Introduction: Esophageal fistula is a rare and serious complication of esophageal cancer. Observation: We report the case of a 33-year-old female patient. The reason for consultation was epigastralgia, post prandial vomiting, purulent bronchial syndrome and fluid dysphagia. Clinical examination revealed a right basal fluid effusion syndrome and limited mouth opening. Thoracic imaging showed a right pulmonary abscess complicating a bronchoesophageal fistula. The digestive fibroscopy showed a necrotizing circumferential budding tumor of the lower third of the esophagus with an orifice on the right side of the esophagus communicating the esophagus and the right basal pyramid. The patient benefited from a feeding gastrostomy. The evolution was marked by the death of the patient three months after her treatment by a cardiorespiratory arrest. Conclusion: Esophageal fistula is a complication of the pre-terminal stage of esophageal cancer. The diagnosis is made by endoscopy and imaging. The treatment remains palliative at this stage.

Application of low-dose hydro-CT using SAFIRE in the evaluation of esophageal cancer.

The esophageal cancer treatment strategy depends on the tumor stage according to the tumor, node and metastasis (TNM) classification. One of the methods recommended for esophageal cancer assessment is computed tomography (CT). The CT imaging is especially important for patients with contraindications for gastroscopy, which is the primary method used for assessing esophageal diseases. The aim of this retrospective study was to evaluate the inter-rater reliability of low-dose hydro-CT with a sinogram-affirmed iterative reconstruction algorithm (SAFIRE) used for the staging of esophageal cancer by 2 independent radiologists. We also evaluated the application of this method for the diagnosis of esophageal cancer. Low-dose hydro-CT was performed in 65 patients, and the raw data were reconstructed with SAFIRE. Obtained images were retrospectively interpreted by 2 independent and experienced radiologists. Histopathological results were used as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the diagnosis of esophageal cancer were calculated for hydro-CT. The examination of the inter-rater reliability level in the assessment of the esophageal cancer stage in the TNM classification was performed by calculating Cohen's kappa coefficient (κ) with square weights and standard errors (SEs) for kappa. Independence tests were also performed (Fisher's exact test - two-tailed, and Pearson's χ2 test). For the diagnosis of esophageal cancer with hydro-CT, a sensitivity of 93%, a specificity of 100%, a PPV of 100%, and a NPV of 88% were observed. In the statistical analyses for the T, N and M stages, κ values greater than 0.90 and significance levels of p < 0.001 were obtained. Hydro-CT using low-dose techniques may be a valuable diagnostic method for staging and diagnosis of esophageal cancer, especially in patients with contraindications for invasive procedures.

Immune characteristics and genetic markers of esophageal cancer by single-cell analysis: implications for immunotherapy.

Esophageal cancer (EC) is one of the most common cancers worldwide. The prognoses for patients with the same stage of EC can vary substantially. The progress of single-cell analysis technology has furthered the understanding of tumor heterogeneity. This paper aimed to apply single-cell analysis to explore the characteristics of the tumor environment of EC and provide a basis for personalized treatment. The latest gene expression data and clinical follow-up information of single-cell sequencing results of EC samples were downloaded from The Cancer Genome Atlas (TCGA) Genomic Data Commons (GDC) Application Programming Interface (API). A differential gene function analysis of the immune infiltration signature agents in the tumor microenvironment (TME) was performed using bioinformatics analytical methods, and potential molecular targets were sought. We identified specific cell subsets in the EC and paracancerous samples, including panel cells, natural killer (NK) cells, exhausted cluster of differentiation (CD)8+ T cells, CD8+ memory T (Tcm) cells, and effector memory T (Tem) cells, including B cell enrichment in the cancer samples. Differences were detected between B cells and monocytes in stage II and III tumors, which may be related to RNA transcription and degradation. The CXCL8 protein was identified as a valid potential prognostic marker. Cell groups with homogenous cell surface markers exhibit intercellular variations that exert a considerable effect on cell function. Our study will contribute to the understanding of the TME and cellular heterogeneity in EC patients and serve as a valuable resource for in-depth exploration of the pathogenesis of EC and the identification of potential therapeutic targets in the future.

Low body mass index is associated with poor treatment outcome following radiotherapy in esophageal squamous cell carcinoma.

We aimed to determine whether patients with esophageal cancer with a low baseline body mass index (BMI) have a poor prognosis following radiotherapy (RT). We retrospectively analyzed data from 50 patients with esophageal cancer to determine whether a low starting BMI (before RT) was associated with a poor outcome. All study participants were diagnosed with non-metastatic esophageal squamous cell carcinoma (SCC). The number of patients at each T stage were as follows: 7 (14%) patients at T1, 18 (36%) at T2, 19 (38%) at T3, and 6 (12%) at T4. Based on BMI, 7 (14%) patients were defined as underweight. A low BMI was common in patients with T3/T4 stage esophageal cancer (7/43, p = 0.01). Overall, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 26.3% and 69.2%, respectively. In univariate analysis, clinical factors associated with poor PFS included being underweight (BMI <18.5 kg/m2; p = 0.011) and a positive N status (p = 0.017). Univariate analysis also revealed that being underweight was associated with a decrease in OS (p = 0.003). However, being underweight was not an independent prognostic factor for PFS and OS. Patients with esophageal SCC with a low starting BMI (BMI <18.5 kg/m2) are more prone to have a negative survival outcome following RT than patients who are considered to be normal weight or overweight. For this reason, it is important that clinicians pay more attention to BMI when treating patients with esophageal SCC.

Implementation of Staging Guidelines in Early Esophageal Cancer: A Study of the Society of Thoracic Surgeons General Thoracic Surgery Database.

To evaluate the adoption and clinical impact of endoscopic resection (ER) in early esophageal cancer. Staging for early esophageal cancer is largely inaccurate. Assessment of the impact of ER on staging accuracy is unknown, as is the implementation of ER. We retrospectively reviewed 2608 patients captured in the Society of Thoracic Surgeons General Thoracic Surgery Database between 2015 and 2020. Patients with clinical T1 and T2 esophageal cancer without nodal involvement (N0) who were treated with upfront esophagectomy were included. Staging accuracy was assessed by clinical-pathologic concordance among patients staged with and without ER. We also sought to measure adherence to National Comprehensive Cancer Network staging guidelines for esophageal cancer staging, specifically the implementation of ER. For early esophageal cancer, computed tomography/positron emission tomography/endoscopic ultrasound (CT/PET/EUS) accurately predicts the pathologic tumor (T) stage 58.5% of the time. The addition of ER to staging was related to a decrease in upstaging from 17.6% to 10.8% ( P =0.01). Adherence to staging guidelines with CT/PET/EUS improved from 58.2% between 2012 and 2014 to 77.9% between 2015 and 2020. However, when ER was added as a staging criterion, adherence decreased to 23.3%. Increased volume of esophagectomies within an institution was associated with increased staging adherence with ER ( P =0.008). The use of CT/PET/EUS for the staging of early esophageal cancer is accurate in only 56.3% of patients. ER may increase staging accuracy as it is related to a decrease in upstaging. ER is poorly utilized in staging of early esophageal cancer. Barriers to the implementation of ER as a staging modality should be identified and corrected.

Development of artificial intelligence for the detection and staging of esophageal cancer

: Computer-assisted diagnosis (CAD) using deep learning, based on convolutional neural networks (CNNs), is rapidly developing in modern society and clinical practice. In the medical field of endoscopy, a CAD system can be used in the detection and staging of superficial esophageal cancer. In the detection of superficial esophageal squamous cell carcinoma (ESCC), several studies were reported as using still images of conventional white-light endoscopy and narrow-band imaging (NBI). The sensitivity of CAD systems is over 90%, and in some reports, higher than that of expert endoscopists. In addition, there is a report using video for a validation set that showed good performance. In diagnosing invasion depth, there are reports using conventional white-light imaging, NBI, and magnifying endoscopy with NBI using still images; there are also reports of intrapapillary capillary loop pattern identification using still images. Using white-light endoscopy and NBI, CAD systems showed sensitivity of 84.1–95.4%, specificity of 73.3–79.2%, and accuracy of 80.9–92.9% for differentiating SM1 cancers from SM2 or SM3 cancers in pathology. Additional systems could accurately classify intrapapillary capillary loop patterns as normal or abnormal, with comparable performance to experienced endoscopists. As for esophageal adenocarcinoma (EAC) that arises in Barrett’s esophagus (BE), there are detection reports that show favorable performance. Furthermore, the CAD system from one report identified the location suitable for biopsy; this is helpful for endoscopists because of the difficulty in determining the location of early EAC in BE. Although these studies are still only at research level, excellent performance has been achieved for detecting and staging of superficial esophageal carcinoma by CAD systems. In the near future, CAD systems will support us in detecting and staging esophageal cancers in daily clinical practice, leading to a better prognosis.

Progress in the Study of Esophageal Cancer-Related Genes and Their Therapeutic Modalities

Esophageal cancer is a prevalent malignant tumor of the digestive tract that has a high mortality rate, posing a severe threat to human life. The development of esophageal cancer is the result of multiple factors, and the process of carcinogenesis is accompanied by abnormal expression of several genes. Mutations in oncogenes and tumor suppressor genes result in changes in their expression and activity, playing a crucial role in the occurrence, development, pathological staging, and prognosis of esophageal cancer. This paper aims to review and study recent research on esophageal cancer, including basic information, related genes, and treatment modalities, in order to explore new ideas and research bases for the diagnosis and treatment of esophageal cancer.

Evaluation of optimal monoenergetic images acquired by dual-energy CT in the diagnosis of T staging of thoracic esophageal cancer

ObjectivesThe 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).MethodsIn 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.ResultsThe 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).ConclusionsMEI (+) 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.

Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer

AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.

Identification of sentinel lymph nodes in esophageal cancer patients using contrast-enhanced EUS with peritumoral injections.

The objective of this pilot study was to compare the performance of contrast-enhanced EUS (CE-EUS)-guided fine-needle aspiration (FNA) with EUS-FNA for lymph node (LN) staging in esophageal cancer. Thirty-seven subjects with esophageal cancer undergoing EUS staging were enrolled, and 30 completed this institutional review board-approved study. A Prosound F75 US system (Hitachi Medical Systems, Tokyo, Japan) with harmonic contrast imaging software and GF-UCT180 curvilinear endoscope (Olympus, Tokyo, Japan) was utilized. All LNs identified by standard EUS were first noted. Sonazoid (dose: 1 mL; GE Healthcare, Oslo, Norway) was administered peritumorally, and all enhanced LNs were recorded. Fine-needle aspiration was performed on LNs considered suspicious by EUS alone, as well as LNs enhanced on CE-EUS. Performance of each modality was compared using FNA cytology as reference standard. A total of 132 LNs were detected with EUS, of which 59 showed enhancement on CE-EUS. Fifty-three LNs underwent FNA, and 22 LNs were determined to be malignant. Among the latter, 10 were considered suspicious by EUS, whereas the other 12 LNs underwent FNA only because of CE-EUS enhancement. Contrast-enhanced EUS showed enhancement in 19 of the 22 malignant LNs. The rate of metastatic node identification from EUS was 45% (10/22), and it was 86% (19/22; P = 0.008) for CE-EUS. Eight subjects (8/30 [27% of study total]) had nodal status upgraded by the addition of CE-EUS, which influenced LN staging and clinical management. Fine-needle aspiration of LNs identified by CE-EUS may increase metastasis positive rate by ruling out LNs not associated with the tumor drainage pattern. In addition, CE-EUS seems to identify more metastatic LNs that would not be biopsied under the standard EUS criteria.

Role of 68Ga-FAPI-04 PET/CT in the Initial Staging of Esophageal Cancer.

To investigate the clinical value of 68Ga-FAPI-04 PET/CT for initial staging of esophageal cancer. A total of 44 newly diagnosed patients with esophageal cancer were included in the analysis on the basis of postoperative pathology or clinical and radiologic follow-up. All primary lesions showed increased 68Ga-FAPI-04 uptake, with an SUVmax of 14.92 ± 6.91. A total of 561 lymph nodes were verified by surgery (507) or clinical and radiologic follow-up (54), of which 92 lymph nodes were diagnosed as showing metastases. Seventy-five lymph nodes with metastases showed positive findings on 68Ga-FAPI-04, with a diameter of about 1.06 ± 0.53 cm and SUVmax of 8.10±4.71. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for lymph node metastasis detection were 81.5%, 99.3%, 96.6%, 96.2%, and 96.5%, respectively. 68Ga-FAPI-04 PET/CT showed good diagnostic performance in detecting lymph node metastases of esophageal cancer.

Comparative study of imaging staging and postoperative pathological staging of esophageal cancer based on smart medical big data.

Esophageal cancer has become a malignant tumor disease with high mortality worldwide. Many cases of esophageal cancer are not very serious in the beginning but become severe in the late stage, so the best treatment time is missed. Less than 20% of patients with esophageal cancer are in the late stage of the disease for 5 years. The main treatment method is surgery, which is assisted by radiotherapy and chemotherapy. Radical resection is the most effective treatment method, but a method for imaging examination of esophageal cancer with good clinical effect has yet to be developed. This study compared imaging staging of esophageal cancer with pathological staging after operation based on the big data of intelligent medical treatment. MRI can be used to evaluate the depth of esophageal cancer invasion and replace CT and EUS for accurate diagnosis of esophageal cancer. Intelligent medical big data, medical document preprocessing, MRI imaging principal component analysis and comparison and esophageal cancer pathological staging experiments were used. Kappa consistency tests were conducted to compare the consistency between MRI staging and pathological staging and between two observers. Sensitivity, specificity and accuracy were determined to evaluate the diagnostic effectiveness of 3.0T MRI accurate staging. Results showed that 3.0T MR high-resolution imaging could show the histological stratification of the normal esophageal wall. The sensitivity, specificity and accuracy of high-resolution imaging in staging and diagnosis of isolated esophageal cancer specimens reached 80%. At present, preoperative imaging methods for esophageal cancer have obvious limitations, while CT and EUS have certain limitations. Therefore, non-invasive preoperative imaging examination of esophageal cancer should be further explored.Esophageal cancer has become a malignant tumor disease with high mortality worldwide. Many cases of esophageal cancer are not very serious in the beginning but become severe in the late stage, so the best treatment time is missed. Less than 20% of patients with esophageal cancer are in the late stage of the disease for 5 years. The main treatment method is surgery, which is assisted by radiotherapy and chemotherapy. Radical resection is the most effective treatment method, but a method for imaging examination of esophageal cancer with good clinical effect has yet to be developed. This study compared imaging staging of esophageal cancer with pathological staging after operation based on the big data of intelligent medical treatment. MRI can be used to evaluate the depth of esophageal cancer invasion and replace CT and EUS for accurate diagnosis of esophageal cancer. Intelligent medical big data, medical document preprocessing, MRI imaging principal component analysis and comparison and esophageal cancer pathological staging experiments were used. Kappa consistency tests were conducted to compare the consistency between MRI staging and pathological staging and between two observers. Sensitivity, specificity and accuracy were determined to evaluate the diagnostic effectiveness of 3.0T MRI accurate staging. Results showed that 3.0T MR high-resolution imaging could show the histological stratification of the normal esophageal wall. The sensitivity, specificity and accuracy of high-resolution imaging in staging and diagnosis of isolated esophageal cancer specimens reached 80%. At present, preoperative imaging methods for esophageal cancer have obvious limitations, while CT and EUS have certain limitations. Therefore, non-invasive preoperative imaging examination of esophageal cancer should be further explored.