Value of EUS in Determining Curative Resectability in Reference to CT and FDG-PET: The Optimal Sequence in Preoperative Staging of Esophageal Cancer?
The separate value of endoscopic ultrasonography (EUS), multidetector computed tomography (CT), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the optimal sequence in staging esophageal cancer has not been investigated adequately.
The staging records of 216 consecutive operable patients with esophageal cancer were reviewed blindly. Different staging strategies were analyzed, and the likelihood ratio (LR) of each module was calculated conditionally on individual patient characteristics. A logistic regression approach was used to determine the most favorable staging strategy.
Initial EUS results were not significantly related to the LRs of initial CT and FDG-PET results. The positive LR (LR+) of EUS-fine-needle aspiration (FNA) was 4, irrespective of CT and FDG-PET outcomes. The LR+ of FDG-PET varied from 13 (negative CT) to 6 (positive CT). The LR+ of CT ranged from 3–4 (negative FDG-PET) to 2–3 (positive FDG-PET). Age, histology, and tumor length had no significant impact on the LRs of the three diagnostic tests.
This study argues in favor of PET/CT rather than EUS as a predictor of curative resectability in esophageal cancer. EUS does not correspond with either CT or FDG-PET. LRs of FDG-PET were substantially different between subgroups of negative and positive CT results and vice versa.
- Messa C, Bettinardi V, Picchio M, et al. PET/CT in diagnostic oncology. Q J Nucl Med Mol Imaging. 2004;48:66–75.
- Reinartz P, Wieres FJ, Schneider W, Schur A, Buell U. Side-by-side reading of PET and CT scans in oncology: which patients might profit from integrated PET/CT? Eur J Nucl Med Mol Imaging. 2004;31:1456–61. CrossRef
- Van Westreenen HL, Heeren PAM, van Dullemen HM et al. Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg. 2005;9:54–61. CrossRef
- Pera M, Pera M. Recent changes in the epidemiology of esophageal cancer. Surg Oncol. 2001;10:81–90. CrossRef
- Pera M, Manterola C, Vidal O, Grande L. Epidemiology of esophageal adenocarcinoma. J Surg Oncol. 2005;92:151–9. CrossRef
- Siesling S, van Dijck JA, Visser O, Coebergh JW; Working Group of The Netherlands Cancer Registry. Trends in incidence of and mortality from cancer in The Netherlands in the period 1989–1998. Eur J Cancer. 2003;39:2521–30. CrossRef
- Steyerberg EW, Homs MYV, Stokvis A, Essink-Bot ML, Siersema PD. Stent placement or brachytherapy for palliation of dysphagia from esophageal cancer: a prognostic model to guide treatment selection. Gastrointest Endosc. 2005;62:333–40. CrossRef
- Clements DM, Bowrey DJ, Havard TJ. The role of staging investigations for oesophago-gastric carcinoma. Eur J Surg Oncol. 2004;30:309–12.
- Westerterp M, van Westreenen HL, Deutekom M, et al. Patients’ perception of diagnostic tests in the preoperative assessment of esophageal cancer. Patient Prefer Adherence 2008:2;157–62.
- Flamen P, Lerut A, van Custem E, et al. The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg. 2000;120:1085–92. CrossRef
- Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT. Detection of distant metastases in esophageal cancer with (18)F-FDG PET. J Nucl Med. 2004;45:980–7.
- Luketich JD, Friedman DM, Weigel TL, et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg. 1999; 68:1133–6; discussion 1136-7. CrossRef
- van Westreenen HL, Westerterp M, Bossuyt PM, et al. Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol. 2004;22:3805–12. CrossRef
- Bar-Shalom R, Guralnik L, Tsalic M, et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging. 2005;32:918–24. CrossRef
- Jadvar H, Henderson RW, Conti PS. 2-Deoxy-2-[F−18]fluoro-d-glucose-positron emission tomography/computed tomography imaging evaluation of esophageal cancer. Mol Imaging Biol. 2006;8:193–200. CrossRef
- Munden RF, Macapinlac HA, Erasmus JJ. Esophageal cancer: The role of integrated CT-PET in initial staging and response assessment after preoperative therapy. J Thorac Imaging. 2006;21:137–45. CrossRef
- Janssens AC, Deng Y, Borsboom GJ, Eijkemans MJ, Habbema JD, Steyerberg EW. A new logistic regression approach for the evaluation of diagnostic test results. Med Decis Making. 2005;25:168–77. CrossRef
- Van Westreenen HL, Westerterp M, Sloof GW, et al. Limited additional value of positron emission tomography in staging oesophageal cancer. Br J Surg. 2007;94:1515–20. CrossRef
- Janssens AC, Steyerberg EW, Jiang Y, Habbema JD, Van Duijn CM, Criswell LA. Value of the HLA-DRB1 shared epitope for predicting radiographic damage in rheumatoid arthritis depends on the individual patient risk profile. J Rheumatol. 2006;33:2383–9.
- Wallace MB, Hawes RH, Sahai AV, Van Velse A, Hoffman BJ. Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc. 2000; 51:309–13. CrossRef
- Westerterp M, van Westreenen HL, Reitsma JB, et al. Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy—systematic review. Radiology. 2005;236:841–51. CrossRef
- Value of EUS in Determining Curative Resectability in Reference to CT and FDG-PET: The Optimal Sequence in Preoperative Staging of Esophageal Cancer?
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Annals of Surgical Oncology
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- L. M. A. Schreurs MD (1)
- A. C. J. W. Janssens PhD (2)
- H. Groen MD, PhD (3)
- P. Fockens MD, PhD (4)
- H. M. van Dullemen MD, PhD (5)
- M. I. van Berge Henegouwen MD, PhD (6)
- G. W. Sloof MD, PhD (7) (9)
- J. Pruim MD, PhD (8)
- J. J. B. van Lanschot MD, PhD (10) (6)
- E. W. Steyerberg PhD (2)
- J. Th. M. Plukker MD, PhD (1)
- Author Affiliations
- 1. Department of Surgery/Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
- 2. Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- 3. Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
- 4. Department of Gastroenterology & Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 5. Department of Gastroenterology, University Medical Center Groningen, Groningen, The Netherlands
- 6. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 7. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 9. Groene Hart Hospital, Gouda, The Netherlands
- 8. Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- 10. Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands