This was a study to compare the diagnostic efficacies of endoscopic ultrasonography (EUS), CT, PET/MR imaging, and PET/CT for the preoperative local and regional staging of esophageal cancer, with postoperative pathologic stage used as the reference standard. Methods: During 1 y, 19 patients with resectable esophageal cancer were enrolled and underwent preoperative EUS, CT, PET/CT, and PET/MR imaging. A chest radiologist and nuclear medicine physician retrospectively reviewed the images and assigned tumor and lymph node stages according to the seventh version of the TNM system and the American Joint Committee on Cancer staging system. Four patients who were treated nonsurgically were excluded from data analysis. The efficacies of EUS, CT, PET/CT, and PET/MR imaging were compared. Results: Primary tumors were correctly staged in 13 (86.7%), 10 (66.7%), and 5 (33.3%) patients at EUS, PET/MR imaging, and CT, respectively (P value ranging from 0.021 to 0.375). The accuracy of determining T1 lesions was 86.7%, 80.0%, and 46.7% for EUS, PET/MR imaging, and CT, respectively. For distinguishing T3 lesions, the accuracy was 93.3% for EUS and 86.7% for both PET/MR imaging and CT. For lymph node staging, the accuracy was 83.3%, 75.0%, 66.7%, and 50.0% for PET/MR imaging, EUS, PET/CT, and CT, respectively. In addition, area-under-the-curve values were 0.800, 0.700, 0.629, and 0.543 for PET/MR imaging, EUS, PET/CT, and CT, respectively. Conclusion: PET/MR imaging demonstrated acceptable accuracy for T staging compared with EUS and, although not statistically significant, even higher accuracy than EUS and PET/CT for prediction of N staging. With adjustments in protocols, PET/MR imaging may provide an important role in preoperative esophageal cancer staging in the future. Accur ate staging of esophageal cancer is critical for decisions on patient treatment. Current practice guidelines for the staging of esophageal cancer include CT of the chest and abdomen, endoscopic ultrasonography (EUS), and PET/CT (1). EUS is a relatively accurate modality for evaluating primary tumor depth compared with CT, which cannot identify the histologic layers of the esophageal wall; thus, the role of CT is usually limited to exclusion of T4 cancers (2,3).Considering nodal metastasis, CT scans, which depend on size criteria, have relatively poor diagnostic performance, as enlarged lymph nodes may be reactive and normal-sized lymph nodes may be positive for metastasis (4,5). Currently, a combination of EUS with or without fine-needle aspiration and PET/CT is widely accepted for assessment of nodal metastasis (1). However, certain lymph nodes that are not immediately adjacent to the esophagus could be dismissed, and the EUS probes, which are typically larger than standard endoscopic probes, are not feasible if the lumen has been narrowed by a large tumor or stricture. PET/CT supports the role of EUS and CT because the maximum standardized uptake value helps identify patients with T1 cancers and pathologic lymph nodes, but the diagnostic accuracy stil...

In this cohort, approximately 85% of individuals have known driver mutations (EGFR 59.4%, KRAS 7.4%, ALK 7.4%, ERBB2 2.6%, ROS1 2.2%, RET 2.2%, MET 1.8%, BRAF 1.1%, and NRAS 0.4%). Seventy percent of smokers and 90% of nonsmokers had defined oncogenic drivers matching the U.S. Food and Drug Administration-approved targeted therapies.

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