Value of EUS in Determining Curative Resectability in Reference to CT and FDG-PET: The Optimal Sequence in Preoperative Staging of Esophageal Cancer?

• Published in: Annals of surgical oncology 2016-12, Vol.23 (Suppl 5), p.1021-1028
• Main Authors: Schreurs, L. M. A., Janssens, A. C. J. W., Groen, H., Fockens, P., van Dullemen, H. M., van Berge Henegouwen, M. I., Sloof, G. W., Pruim, J., van Lanschot, J. J. B., Steyerberg, E. W., Plukker, J. Th. M.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Female; Fluorodeoxyglucose F18; Humans; Likelihood Functions; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography; Neoplasm Staging; Oncology; Patient Selection; Positron-Emission Tomography; Preoperative Period; Prospective Studies; Radiopharmaceuticals; Surgery; Surgical Oncology; Thoracic Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1738-8

Background The separate value of endoscopic ultrasonography (EUS), multidetector computed tomography (CT), and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the optimal sequence in staging esophageal cancer has not been investigated adequately. Methods The staging records of 216 consecutive operable patients with esophageal cancer were reviewed blindly. Different staging strategies were analyzed, and the likelihood ratio (LR) of each module was calculated conditionally on individual patient characteristics. A logistic regression approach was used to determine the most favorable staging strategy. Results Initial EUS results were not significantly related to the LRs of initial CT and FDG-PET results. The positive LR (LR+) of EUS-fine-needle aspiration (FNA) was 4, irrespective of CT and FDG-PET outcomes. The LR+ of FDG-PET varied from 13 (negative CT) to 6 (positive CT). The LR+ of CT ranged from 3–4 (negative FDG-PET) to 2–3 (positive FDG-PET). Age, histology, and tumor length had no significant impact on the LRs of the three diagnostic tests. Conclusions This study argues in favor of PET/CT rather than EUS as a predictor of curative resectability in esophageal cancer. EUS does not correspond with either CT or FDG-PET. LRs of FDG-PET were substantially different between subgroups of negative and positive CT results and vice versa.