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Analyzing the post-contrast attenuation of the esophageal wall on routine contrast-enhanced MDCT examination can improve the diagnostic accuracy in response evaluation of the squamous cell esophageal carcinoma to neoadjuvant chemoradiotherapy in comparison with the esophageal wall thickness

  • Aleksandra Djuric-StefanovicEmail author
  • Aleksandra Jankovic
  • Dusan Saponjski
  • Marjan Micev
  • Suzana Stojanovic-Rundic
  • Milena Cosic-Micev
  • Predrag Pesko
Hollow Organ GI

Abstract

Purpose

To evaluate the accuracy of the multidetector computed tomography (MDCT) in the response evaluation of the esophageal squamous cell carcinoma (ESCC) to neoadjuvant chemoradiotherapy (nCRT) by analyzing the thickness and post-contrast attenuation of the esophageal wall after the nCRT.

Methods

Contrast-enhanced (CE)-MDCT examinations in portal venous phase of one hundred patients with locally advanced ESCC who received nCRT and underwent esophageal resection and histopathology assessment of tumor regression grade (TRG) were retrospectively analyzed by measuring the maximal thickness and mean density of the esophageal wall in the segment involved by tumor and visually searching for hyperdense foci within it. Diagnostic performance was evaluated using the ROC analysis.

Results

Average attenuation of the esophageal wall had stronger diagnostic performance for predicting pathologic complete regression (pCR) (AUC = 0.994; p < 0.001) in relation to maximal esophageal wall thickness (AUC = 0.731; p < 0.001). Maximal esophageal wall thickness ≤ 9 mm and average attenuation of the esophageal wall ≤ 64 HU predicted pCR with the sensitivity, specificity, and overall accuracy of 62.5%, 77.9%, and 73%, and 96.9%, 98.5%, and 98%, respectively. Combination of both cutoff values enabled correct assessment of pCR with the 100% accuracy. Visual detection of the hyperdense focus within the esophageal wall predicted pCR with the sensitivity, specificity, and overall accuracy values of 100%, 94.1%, and 96%, respectively.

Conclusion

Visual analysis and measurement of post-contrast attenuation of the esophageal wall after the nCRT can improve diagnostic accuracy of MDCT in the response evaluation of the ESCC to nCRT in comparison with measuring the esophageal wall thickness.

Keywords

Esophageal neoplasms Multidetector computed tomography Neoadjuvant therapy Treatment outcome 

Abbreviations

nCRT

Neoadjuvant chemoradiotherapy

TRG

Tumor regression grade

pCR

Pathologic complete regression

pPR

Pathologic partial regression

CR

Complete response

PR

Partial response

EC

Esophageal carcinoma

ESCC

Esophageal squamous cell carcinoma

MDCT

Multidetector computed tomography

CE-MDCT

Contrast-enhanced MDCT

ROC

Receiving operation characteristics

AUC

Area under the curve

CI

Confidence interval

Pre-nCRT MDCT examination

A MDCT examination before the nCRT

Post-nCRT MDCT examination

A MDCT examination after the nCRT

PPV

Positive predictive value

NPV

Negative predictive value

Notes

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MRClinical Center of SerbiaBelgradeSerbia
  2. 2.Department of Pathology, First Surgery University ClinicClinical Center of SerbiaBelgradeSerbia
  3. 3.Clinic for Radiation Oncology and Diagnostics, Department of Radiation OncologyInstitute for Oncology and Radiology of SerbiaBelgradeSerbia
  4. 4.First Surgery University ClinicClinical Center of SerbiaBelgradeSerbia
  5. 5.Faculty of MedicineUniversity of BelgradeBelgradeSerbia

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