Accuracy of contemporary oesophageal cancer lymph node staging with radiological-pathological correlation

Foley, Kieran; Christian, Adam; Fielding, Patrick; Lewis, Wyn G.; Roberts, S. A.

doi:10.1016/j.crad.2017.02.022

Cited by 41 publications

(37 citation statements)

References 24 publications

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“…This is in line with previous studies reporting similar poor radiological cN staging accuracy, 6,16-18 with a sensitivity and specificity of CT, EUS, and PET/CT of 39.7% and 77.3%, 42.6% and 75%, and 35.3% and 90.9%, respectively. 17 Our study confirms that patients who did not have any pretreatment nodal involvement (prepN0) have a better prognosis than patients who had no residual disease in the resected lymph nodes (ypN0), but who did have pretreatment nodal involvement (prepN ?). 5 This is in contrast with Donohoe et al, 3 who found that clinically node-positive patients who had complete nodal response had no difference in survival compared with initially clinically node-negative patients.…”

Section: Discussionsupporting

confidence: 81%

External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer

et al. 2019

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Background. This study was conducted to validate a pretreatment (i.e. prior to neoadjuvant chemoradiotherapy) pathological staging system in the resection specimen after neoadjuvant chemoradiotherapy for esophageal cancer. The study investigated the prognostic value of pretreatment pathological T and N categories (prepT and prepN categories) in both an independent and a combined patient cohort. Methods. Patients with esophageal cancer treated with neoadjuvant chemotherapy and esophagectomy between 2012 and 2015 were included. PrepT and prepN categories were estimated based on the extent of tumor regression and regressional changes of lymph nodes in the resection specimen. The difference in Akaike's information criterion (DAIC) was used to assess prognostic performance. PrepN and ypN categories were combined to determine the effect of nodal sterilization on prognosis. A multivariable Cox regression model was used to identify combined prepN and ypN categories as independent prognostic factors. Results. The prognostic strength of the prepT category was better than the cT and ypT categories (DAIC 7.7 vs. 3.0 and 2.9, respectively), and the prognostic strength of the prepN category was better than the cN category and similar to the ypN category (DAIC 29.2 vs. -1.0 and 27.9, respectively). PrepN ? patients who became ypN0 had significantly worse survival than prepN0 patients (2-year overall survival 69% vs. 86% in 137 patients; p = 0.044). Similar results were found in a combined cohort of 317 patients (2-year overall survival 62% vs. 85%; p = 0.002). Combined prepN/ypN stage was independently associated with overall survival. Conclusions. These results independently confirm the prognostic value of prepTNM staging. PrepTNM staging is of additional prognostic value to cTNM and ypTNM. PrepN0/ypN0 patients have a better survival than prepN ?/ ypN0 patients.Potentially curative treatment for esophageal cancer consists of neoadjuvant chemo(radio)therapy followed by surgery. After neoadjuvant therapy, the percentage of residual tumor cells and lymph node regression is of prognostic value. Several studies investigated the impact of tumor regression and classified histopathological response to neoadjuvant therapy and its correlation to prognosis.

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Section: Discussionsupporting

confidence: 81%

External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer

et al. 2019

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“…EUS-FNA of high peri-oesophageal and coeliac axis nodes can also be performed as a 'problem-solver', which adds valuable information when clinicians are deciding whether the patient is suitable for radical therapy. The sensitivity of CT, EUS and PET was 39.7%, 42.6% and 35.3%, respectively and the specificity was 77.3%, 75.0% and 90.9%, respectively [41]. The main reason for such poor sensitivity was that 82% of lymph node metastases measured less than 6 mm and 44% less than 2 mm (classed as micro-metastases), which cannot be visualised on current imaging modalities.…”

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confidence: 99%

“…There are extensive data available on the accuracy of lymph node staging. In general, all staging investigations tend to 'under-stage' lymph node metastases due to their respective limitations [41]. One meta-analysis found the sensitivity of CT, EUS and PET/CT for the detection of regional lymph node metastases was 50%, 80% and 57%, respectively [7].…”

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confidence: 99%

Novel imaging techniques in staging oesophageal cancer

Foley

Findlay

2018

Best Practice & Research Clinical Gastroenterology

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“…For patients being considered for a curative pathway, endoscopic ultrasound (EUS) and 18F-fluorodeoxyglu-cose positron emission tomography/CT (18F-FDG PET/ CT) are performed due to the high sensitivity and specificity of EUS for local tumor and nodal staging; and 18F-FDG PET for distant metastases [17][18][19]. This aims to reduce the futile surgery rate.…”

Section: The Imaging Pathway At Stagingmentioning

confidence: 99%

Radiomics in esophageal and gastric cancer

et al. 2018

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Esophageal, esophago-gastric, and gastric cancers are major causes of cancer morbidity and cancer death. For patients with potentially resectable disease, multimodality treatment is recommended as it provides the best chance of survival. However, quality of life may be adversely affected by therapy, and with a wide variation in outcome despite multi-modality therapy, there is a clear need to improve patient stratification. Radiomic approaches provide an opportunity to improve tumor phenotyping. In this review we assess the evidence to date and discuss how these approaches could improve outcome in esophageal, esophago-gastric, and gastric cancer.

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Accuracy of contemporary oesophageal cancer lymph node staging with radiological-pathological correlation

Cited by 41 publications

References 24 publications

External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer

External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer

Novel imaging techniques in staging oesophageal cancer

Radiomics in esophageal and gastric cancer

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