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Staging of oesophageal cancer

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The reported sensitivity for detecting the primary tumour is 91–100%, but increased uptake may also be seen in oesophagitis... False-negative results may occur in very small T1 tumours... Nodal staging is based on infiltration of local nodes only, however, the number of nodes involved is an important prognostic indicator (more than four nodes or greater than 10% of nodes involved carries a poor prognosis)... The presence of metastases in the perioesophageal nodes does not preclude surgery, as they will be removed en bloc at the time of resection... In one series the sensitivity was 19% with a PPV of 33% and in this series only 28% of the metastatic nodes were greater than 10 mm in size, 35% were 5–9 mm and 36% were less than 5 mm... Consigliere found that CT had an overall accuracy of 69% for detection of nodal enlargement, however, only 38% of the identified enlarged nodes were malignant and 57% of unidentified normal-sized nodes contained tumour... In this study the low sensitivity for local nodes on FDG PET contrasted with the results of EUS which had a sensitivity of 81%, with specificity of 67% and accuracy of 74%... In the 21 false-negative CT scans the PET was positive in 11 (62%) and in the 12 false-negative PET scans the CT was positive in 4 (33%)... Other studies comparing FDG-PET to the combination of EUS and CT found similar results with a sensitivity of 74% (CT/EUS 47%), specificity 90% (CT/EUS 78%) and accuracy 82% (CT/EUS 64%)... In this study PET under-staged the extent of nodal disease in 19 (49%), whereas the CT/EUS combination over-staged the nodal stage in 14 (36%)... The high false-negative rate for PET may be a result of the high incidence of micrometastases... FDG PET is best for distant metastases and regional nodal metastases, although is not widely available... In those patients considered suitable for resection EUS is then performed for accurate local staging and FDG PET should be used if the previous studies suggest locally resectable disease, to exclude distant metastases undetected by CT.

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Endoscopic ultrasound of patients with oesophageal cancer with mediastinal invasion. (a) Oesophageal tumour (T4): the tumour (white arrow) is adherent to the left pulmonary vein (white cross) with loss of the intervening plane. (b) Oesophageal tumour (T4): the tumour (broken white arrow) has breached the pleura (white arrow) to invade the right lung.
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Fig1: Endoscopic ultrasound of patients with oesophageal cancer with mediastinal invasion. (a) Oesophageal tumour (T4): the tumour (white arrow) is adherent to the left pulmonary vein (white cross) with loss of the intervening plane. (b) Oesophageal tumour (T4): the tumour (broken white arrow) has breached the pleura (white arrow) to invade the right lung.

Mentions: The tumour usually appears as circumferential thickening of the wall of hypoechoic or mixed echo pattern with distortion of the layers. Accurate assessment of the depth of invasion through the mucosa, submucosa and muscularis propria can be made. T1 and T2 tumours can be differentiated and extension of tumour through the oesophageal wall and invasion into the surrounding structures identified (Fig. 1).Figure 1


Staging of oesophageal cancer
Endoscopic ultrasound of patients with oesophageal cancer with mediastinal invasion. (a) Oesophageal tumour (T4): the tumour (white arrow) is adherent to the left pulmonary vein (white cross) with loss of the intervening plane. (b) Oesophageal tumour (T4): the tumour (broken white arrow) has breached the pleura (white arrow) to invade the right lung.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4554710&req=5

Fig1: Endoscopic ultrasound of patients with oesophageal cancer with mediastinal invasion. (a) Oesophageal tumour (T4): the tumour (white arrow) is adherent to the left pulmonary vein (white cross) with loss of the intervening plane. (b) Oesophageal tumour (T4): the tumour (broken white arrow) has breached the pleura (white arrow) to invade the right lung.
Mentions: The tumour usually appears as circumferential thickening of the wall of hypoechoic or mixed echo pattern with distortion of the layers. Accurate assessment of the depth of invasion through the mucosa, submucosa and muscularis propria can be made. T1 and T2 tumours can be differentiated and extension of tumour through the oesophageal wall and invasion into the surrounding structures identified (Fig. 1).Figure 1

View Article: PubMed Central

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The reported sensitivity for detecting the primary tumour is 91–100%, but increased uptake may also be seen in oesophagitis... False-negative results may occur in very small T1 tumours... Nodal staging is based on infiltration of local nodes only, however, the number of nodes involved is an important prognostic indicator (more than four nodes or greater than 10% of nodes involved carries a poor prognosis)... The presence of metastases in the perioesophageal nodes does not preclude surgery, as they will be removed en bloc at the time of resection... In one series the sensitivity was 19% with a PPV of 33% and in this series only 28% of the metastatic nodes were greater than 10 mm in size, 35% were 5–9 mm and 36% were less than 5 mm... Consigliere found that CT had an overall accuracy of 69% for detection of nodal enlargement, however, only 38% of the identified enlarged nodes were malignant and 57% of unidentified normal-sized nodes contained tumour... In this study the low sensitivity for local nodes on FDG PET contrasted with the results of EUS which had a sensitivity of 81%, with specificity of 67% and accuracy of 74%... In the 21 false-negative CT scans the PET was positive in 11 (62%) and in the 12 false-negative PET scans the CT was positive in 4 (33%)... Other studies comparing FDG-PET to the combination of EUS and CT found similar results with a sensitivity of 74% (CT/EUS 47%), specificity 90% (CT/EUS 78%) and accuracy 82% (CT/EUS 64%)... In this study PET under-staged the extent of nodal disease in 19 (49%), whereas the CT/EUS combination over-staged the nodal stage in 14 (36%)... The high false-negative rate for PET may be a result of the high incidence of micrometastases... FDG PET is best for distant metastases and regional nodal metastases, although is not widely available... In those patients considered suitable for resection EUS is then performed for accurate local staging and FDG PET should be used if the previous studies suggest locally resectable disease, to exclude distant metastases undetected by CT.

No MeSH data available.


Related in: MedlinePlus