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Radiologic Assessment of Esophageal Cancer

  • Valeria M. MoncayoEmail author
  • A. Tuba Kendi
  • David M. Schuster
Chapter

Abstract

Imaging in esophageal cancer plays a pivotal role, including diagnosis, staging, and evaluation of response to treatment. The specific features of the different conventional anatomic modalities such as esophagograms, endoscopic ultrasound, CT, and MRI are explained. In addition, the role of PET/CT, a functional and anatomic modality, is illustrated. In this chapter, the specific role of each modality is explained for each of the pillars of staging (T,N,M) along with evidence-based facts and most relevant guidelines in the use of imaging, including the updated eighth edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) cancer staging manuals.

Keywords

Esophagoscopy Esophagogram Computed tomography Positron emission tomography Magnetic resonance Esophageal ultrasound 

References

  1. 1.
    Kim TJ, Kim HY, Lee KW, Kim MS. Multimodality assessment of esophageal cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2009;29(2):403–21.PubMedCrossRefGoogle Scholar
  2. 2.
    Napier KJ, Scheerer M, Misra S. Esophageal cancer: areview of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 2014;6(5):112–20.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    American Cancer Socity. Esophageal Cancer Key Statistics; 2017. https://www.cancer.org/cancer/esophagus-cancer/about/key-statistics.html.
  4. 4.
    Shin KE, Lee KS, Choi JY, Kim HK, Shim YM. Esophageal malignancy and staging. Semin Roentgenol. 2013;48(4):344–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Li Z, Rice TW. Diagnosis and staging of cancer of the esophagus and esophagogastric junction. Surg Clin North Am. 2012;92(5):1105–26.PubMedCrossRefGoogle Scholar
  6. 6.
    Sonavane S, Watts J Jr, Terry N, Singh SP. Expected and unexpected imaging features after oesophageal cancer treatment. Clin Radiol. 2014;69(8):e358–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Rice TW. Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin N Am. 2000;10(3):471–85.PubMedGoogle Scholar
  8. 8.
    Levine MS, Chu P, Furth EE, Rubesin SE, Laufer I, Herlinger H. Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis. AJR Am J Roentgenol. 1997;168(6):1423–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Flamen P, Lerut A, Van Cutsem E, De Wever W, Peeters M, Stroobants S, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol. 2000;18(18):3202–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Esteves FP, Schuster DM, Halkar RK. Gastrointestinal tract malignancies and positron emission tomography: an overview. Semin Nucl Med. 2006;36(2):169–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Wallace MB, Nietert PJ, Earle C, Krasna MJ, Hawes RH, Hoffman BJ, et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg. 2002;74(4):1026–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6(2):119–30.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010;17(7):1721–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001;49(4):534–9.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Foley KG, Morgan C, Roberts SA, Crosby T. Impact of positron emission tomography and endoscopic ultrasound length of disease difference on treatment planning in patients with oesophageal cancer. Clin Oncol. 2017;29(11):760–6.CrossRefGoogle Scholar
  16. 16.
    Wang WL, Chiu SY, Lee CT, Tseng CH, Chen CC, Han ML, et al. A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma. J Gastroenterol Hepatol. 2018;33(6):1248–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Ulla M, Gentile E, Yeyati EL, Diez ML, Cavadas D, Garcia-Monaco RD, et al. Pneumo-CT assessing response to neoadjuvant therapy in esophageal cancer: imaging-pathological correlation. World J Gastrointest Oncol. 2013;5(12):222–9.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Puli SR, Reddy JB, Bechtold ML, Antillon D, Ibdah JA, Antillon MR. Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol. 2008;14(10):1479–90.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Riddell AM, Allum WH, Thompson JN, Wotherspoon AC, Richardson C, Brown G. The appearances of oesophageal carcinoma demonstrated on high-resolution, T2-weighted MRI, with histopathological correlation. Eur Radiol. 2007;17(2):391–9.PubMedCrossRefGoogle Scholar
  20. 20.
    van Rossum PS, van Hillegersberg R, Lever FM, Lips IM, van Lier AL, Meijer GJ, et al. Imaging strategies in the management of oesophageal cancer: what’s the role of MRI? Eur Radiol. 2013;23(7):1753–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Yasuda S, Raja S, Hubner KF. Application of whole-body positron emission tomography in the imaging of esophageal cancer: report of a case. Surg Today. 1995;25(3):261–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Karaosmanoglu AD, Blake MA. Applications of PET-CT in patients with esophageal cancer. Diagn Interv Radiol. 2012;18(2):171–82.PubMedGoogle Scholar
  23. 23.
    Kato H, Kuwano H, Nakajima M, Miyazaki T, Yoshikawa M, Ojima H, et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002;94(4):921–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Foley KG, Fielding P, Lewis WG, Karran A, Chan D, Blake P, et al. Prognostic significance of novel (1)(8)F-FDG PET/CT defined tumour variables in patients with oesophageal cancer. Eur J Radiol. 2014;83(7):1069–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Pan L, Gu P, Huang G, Xue H, Wu S. Prognostic significance of SUV on PET/CT in patients with esophageal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2009;21(9):1008–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Goerres GW, Von Schulthess GK, Hany TF. Positron emission tomography and PET CT of the head and neck: FDG uptake in normal anatomy, in benign lesions, and in changes resulting from treatment. AJR Am J Roentgenol. 2002;179(5):1337–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Goense L, Meziani J, van Rossum PSN, Wessels FJ, Lam M, van Hillegersberg R, et al. Cervical ultrasonography has no additional value over negative 18F-FDG PET/CT scans for diagnosing cervical lymph node metastases in patients with oesophageal cancer. Eur Radiol. 2018;28(5): 2031–37.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Nishimura H, Tanigawa N, Hiramatsu M, Tatsumi Y, Matsuki M, Narabayashi I. Preoperative esophageal cancer staging: magnetic resonance imaging of lymph node with ferumoxtran-10, an ultrasmall superparamagnetic iron oxide. J Am Coll Surg. 2006;202(4):604–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Alper F, Turkyilmaz A, Kurtcan S, Aydin Y, Onbas O, Acemoglu H, et al. Effectiveness of the STIR turbo spin-echo sequence MR imaging in evaluation of lymphadenopathy in esophageal cancer. Eur J Radiol. 2011;80(3):625–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Rasanen JV, Sihvo EI, Knuuti MJ, Minn HR, Luostarinen ME, Laippala P, et al. Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol. 2003;10(8):954–60.PubMedCrossRefGoogle Scholar
  31. 31.
    Godoy MC, Bruzzi JF, Viswanathan C, Truong MT, Guimaraes MD, Hofstetter WL, et al. Multimodality imaging evaluation of esophageal cancer: staging, therapy assessment, and complications. Abdom Imaging. 2013;38(5):974–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Moon SH, Kim HS, Hyun SH, Choi YS, Zo JI, Shim YM, et al. Prediction of occult lymph node metastasis by metabolic parameters in patients with clinically N0 esophageal squamous cell carcinoma. J Nucl Med. 2014;55(5):743–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Hsu PK, Lin KH, Wang SJ, Huang CS, Wu YC, Hsu WH. Preoperative positron emission tomography/computed tomography predicts advanced lymph node metastasis in esophageal squamous cell carcinoma patients. World J Surg. 2011;35(6):1321–6.PubMedCrossRefGoogle Scholar
  34. 34.
    National Comprehensive Cancer Network Guidelines. Esophageal and Esophagogastric Junction Cancers (Version 4.2017); 2017. http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf.
  35. 35.
    Lee G, I H, Kim SJ, Jeong YJ, Kim IJ, Pak K, et al. Clinical implication of PET/MR imaging in preoperative esophageal cancer staging: comparison with PET/CT, endoscopic ultrasonography, and CT. J Nucl Med. 2014;55(8):1242–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995;76(7):1120–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Bruzzi JF, Munden RF, Truong MT, Marom EM, Sabloff BS, Gladish GW, et al. PET/CT of esophageal cancer: its role in clinical management. Radiographics. 2007;27(6):1635–52.PubMedCrossRefGoogle Scholar
  38. 38.
    van Vliet EP, Heijenbrok-Kal MH, Hunink MG, Kuipers EJ, Siersema PD. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer. 2008;98(3):547–57.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Barber TW, Duong CP, Leong T, Bressel M, Drummond EG, Hicks RJ. 18F-FDG PET/CT has a high impact on patient management and provides powerful prognostic stratification in the primary staging of esophageal cancer: a prospective study with mature survival data. J Nucl Med. 2012;53(6):864–71.PubMedCrossRefGoogle Scholar
  40. 40.
    Chatterton BE, Ho Shon I, Baldey A, Lenzo N, Patrikeos A, Kelley B, et al. Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging. 2009;36(3):354–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Mainenti PP, Mancini M, Mainolfi C, Camera L, Maurea S, Manchia A, et al. Detection of Colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. Abdom Imaging. 2010;35(5):511–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment for carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg. 1981;194(4):438–46.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Clark GW, Peters JH, Ireland AP, Ehsan A, Hagen JA, Kiyabu MT, et al. Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. Ann Thorac Surg. 1994;58(3):646–53; discussion 53-4PubMedCrossRefGoogle Scholar
  44. 44.
    Omloo JM, van Heijl M, Hoekstra OS, van Berge Henegouwen MI, van Lanschot JJ, Sloof GW. FDG-PET parameters as prognostic factor in esophageal cancer patients: a review. Ann Surg Oncol. 2011;18(12):3338–52.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Hatt M, Visvikis D, Pradier O, Cheze-le Rest C. Baseline (1)(8)F-FDG PET image-derived parameters for therapy response prediction in oesophageal cancer. Eur J Nucl Med Mol Imaging. 2011;38(9):1595–606.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Brucher BL, Weber W, Bauer M, Fink U, Avril N, Stein HJ, et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg. 2001;233(3):300–9.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Kato H, Kuwano H, Nakajima M, Miyazaki T, Yoshikawa M, Masuda N, et al. Usefulness of positron emission tomography for assessing the response of neoadjuvant chemoradiotherapy in patients with esophageal cancer. Am J Surg. 2002;184(3):279–83.PubMedCrossRefGoogle Scholar
  48. 48.
    Kroep JR, Van Groeningen CJ, Cuesta MA, Craanen ME, Hoekstra OS, Comans EF, et al. Positron emission tomography using 2-deoxy-2-[18F]-fluoro-D-glucose for response monitoring in locally advanced gastroesophageal cancer; a comparison of different analytical methods. Mol Imaging Biol. 2003;5(5):337–46.PubMedCrossRefGoogle Scholar
  49. 49.
    Smith JW, Moreira J, Abood G, Aranha GV, Nagda S, Wagner RH, et al. The influence of (18)flourodeoxyglucose positron emission tomography on the management of gastroesophageal junction carcinoma. Am J Surg. 2009;197(3):308–12.PubMedCrossRefGoogle Scholar
  50. 50.
    Lantos JE, Levine MS, Rubesin SE, Lau CT, Torigian DA. Comparison between esophagography and chest computed tomography for evaluation of leaks after esophagectomy and gastric pull-through. J Thorac Imaging. 2013;28(2):121–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Shoji Y, Takeuchi H, Fukuda K, Nakamura R, Wada N, Kawakubo H, et al. Air bubble sign: a new screening method for anastomotic leakage after esophagectomy for esophageal cancer. Ann Surg Oncol. 2018;25(4):1061–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Lainas P, Fuks D, Gaujoux S, Machroub Z, Fregeville A, Perniceni T, et al. Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer. Br J Surg. 2017;104(10):1346–54.PubMedCrossRefGoogle Scholar
  53. 53.
    van Westreenen HL, Cobben DC, Jager PL, van Dullemen HM, Wesseling J, Elsinga PH, et al. Comparison of 18F-FLT PET and 18F-FDG PET in esophageal cancer. J Nucl Med. 2005;46(3):400–4.PubMedGoogle Scholar
  54. 54.
    Han D, Yu J, Zhong X, Fu Z, Mu D, Zhang B, et al. Comparison of the diagnostic value of 3-deoxy-3-18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of regional lymph node in thoracic esophageal squamous cell carcinoma: a pilot study. Dis Esophagus. 2012;25(5):416–26.PubMedCrossRefGoogle Scholar
  55. 55.
    Park SH, Ryu JS, Oh SJ, Park SI, Kim YH, Jung HY, et al. The feasibility of (18)F-fluorothymidine PET for prediction of tumor response after induction chemotherapy followed by chemoradiotherapy with S-1/oxaliplatin in patients with resectable esophageal cancer. Nucl Med Mol Imaging. 2012;46(1):57–64.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Chen H, Li Y, Wu H, Sun L, Lin Q, Zhao L, et al. 3′-Deoxy-3′-[F]-fluorothymidine PET/CT in early determination of prognosis in patients with esophageal squamous cell cancer: comparison with [F]-FDG PET/CT. Strahlenther Onkol. 2015;191(2):141–52.Google Scholar
  57. 57.
    Chao KS. Functional imaging for early prediction of response to chemoradiotherapy: 3′-deoxy-3′-18F-fluorothymidine positron emission tomography--a clinical application model of esophageal cancer. Semin Oncol. 2006;33(6 Suppl 11):S59–63.PubMedCrossRefGoogle Scholar
  58. 58.
    Suzuki S, Kaira K, Ohshima Y, Ishioka NS, Sohda M, Yokobori T, et al. Biological significance of fluorine-18-alpha-methyltyrosine (FAMT) uptake on PET in patients with oesophageal cancer. Br J Cancer. 2014;110(8):1985–91.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Liu S, Zheng H, Pan X, Chen L, Shi M, Guan Y, et al. Texture analysis of CT imaging for assessment of esophageal squamous cancer aggressiveness. J Thorac Dis. 2017;9(11):4724–32.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Wang ZL, Zhou ZG, Chen Y, Li XT, Sun YS. Support vector machines model of computed tomography for assessing lymph node metastasis in esophageal cancer with neoadjuvant chemotherapy. J Comput Assist Tomogr. 2017;41(3):455–60.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Valeria M. Moncayo
    • 1
    Email author
  • A. Tuba Kendi
    • 2
  • David M. Schuster
    • 1
  1. 1.Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging SciencesEmory UniversityAtlantaUSA
  2. 2.Department of RadiologyMayo ClinicRochesterUSA

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