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

• Published in: European radiology 2013-09, Vol.23 (9), p.2492-2502
• Main Authors: Konieczny, Agnieszka, Meyer, Philipp, Schnider, Annelies, Komminoth, Paul, Schmid, Mathias, Lombriser, Norbert, Weishaupt, Dominik
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Biopsy; Cancer therapies; Chemoradiotherapy - methods; Diagnostic Radiology; Endoscopy; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - surgery; Esophageal Neoplasms - therapy; Female; Gastrointestinal; Humans; Image Processing, Computer-Assisted; Imaging; Internal Medicine; Interventional Radiology; Lymphatic Metastasis; Male; Medical prognosis; Medicine; Medicine & Public Health; Metabolism; Metastasis; Middle Aged; Neoadjuvant Therapy - methods; Neoplasm Staging - methods; Neuroradiology; Oncology; Patients; Predictive Value of Tests; Radiology; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Surgery; Tomography; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2844-8

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.