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

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To assess the diagnostic accuracy of 64-multidetector CT (MDCT) for restaging of patients with oesophageal cancer undergoing neoadjuvant therapy.

Methods

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.

Results

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).

Conclusion

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.

Key Points

• 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.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CT:

computed tomography

CR:

histopathological complete response

FDG-PET:

fluoro-2-deoxyglucose positron emission tomography

Gy:

gray

kVp:

peak kilovoltage

mAs:

milliampere second

MDCT:

multidetector-row computed tomography

NR:

histopathological none response

PET/CT:

fluoro-2-deoxyglucose positron emission tomography performed in a hybrid fashion with computed tomography

TRG:

tumour regression grade

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Authors and Affiliations

  1. Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, CH-8063, Zürich, Switzerland

    Agnieszka Konieczny & Dominik Weishaupt

  2. Department of Visceral Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland

    Philipp Meyer & Annelies Schnider

  3. Institute of Pathology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland

    Paul Komminoth

  4. Clinic of Medical Oncology and Hematology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland

    Mathias Schmid

  5. Department of Radio-Oncology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland

    Norbert Lombriser

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  1. Agnieszka Konieczny
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Correspondence to Dominik Weishaupt.

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Konieczny, A., Meyer, P., Schnider, A. et al. Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer. Eur Radiol 23, 2492–2502 (2013). https://doi.org/10.1007/s00330-013-2844-8

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  • DOI: https://doi.org/10.1007/s00330-013-2844-8

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