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Staging of oesophageal cancer

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T4 tumours are inferred by the loss of fat planes between the tumour and adjacent structures, although this may be difficult in very thin patients (Fig. 2)... Aortic invasion, which is found in only 6% of patients at post mortem, is diagnosed if the angle of contact between the tumour and aorta is greater than 90°, if the angle of contact is less than 45° there is no invasion... Using this criterion produces a large number of indeterminate results and an overall accuracy of 55%, and loss of the triangular fat space between the oesophagus, aorta and spine is a better sign of invasion with an improved accuracy of 86%... 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%... Overall, the sensitivity of CT for screening for distant metastases is 41–62%, with specificity of 69–83% and accuracy of 63–90%... PET is an excellent method for screening for distant metastases and is superior to CT (see Fig. 2)... 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%)... 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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CT of patient with oesophageal cancer and liver metastases and peri-oesophageal lymph node (arrowhead).
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Fig3: CT of patient with oesophageal cancer and liver metastases and peri-oesophageal lymph node (arrowhead).

Mentions: CT has well-known limitations in the accuracy of nodal staging as size is used as the only criterion. Small lymph nodes containing metastases, particularly the perioesophageal nodes, will not be diagnosed as infiltrated and the patient will be under-staged (Fig. 3). False-positive examinations are due to enlarged inflammatory nodes being called malignant, and, as it is important not to over-stage patients and deprive them of potentially curative surgery, any enlarged node on CT should have tissue confirmation if this CT finding alone would change therapy. If mediastinal lymph nodes with a short axis greater than 10 mm are considered abnormal, the accuracy for CT diagnosis of node involvement is 51–70%. 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.[15] Consigliere[16] 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.Figure 3


Staging of oesophageal cancer
CT of patient with oesophageal cancer and liver metastases and peri-oesophageal lymph node (arrowhead).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4554710&req=5

Fig3: CT of patient with oesophageal cancer and liver metastases and peri-oesophageal lymph node (arrowhead).
Mentions: CT has well-known limitations in the accuracy of nodal staging as size is used as the only criterion. Small lymph nodes containing metastases, particularly the perioesophageal nodes, will not be diagnosed as infiltrated and the patient will be under-staged (Fig. 3). False-positive examinations are due to enlarged inflammatory nodes being called malignant, and, as it is important not to over-stage patients and deprive them of potentially curative surgery, any enlarged node on CT should have tissue confirmation if this CT finding alone would change therapy. If mediastinal lymph nodes with a short axis greater than 10 mm are considered abnormal, the accuracy for CT diagnosis of node involvement is 51–70%. 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.[15] Consigliere[16] 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.Figure 3

View Article: PubMed Central

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

T4 tumours are inferred by the loss of fat planes between the tumour and adjacent structures, although this may be difficult in very thin patients (Fig. 2)... Aortic invasion, which is found in only 6% of patients at post mortem, is diagnosed if the angle of contact between the tumour and aorta is greater than 90°, if the angle of contact is less than 45° there is no invasion... Using this criterion produces a large number of indeterminate results and an overall accuracy of 55%, and loss of the triangular fat space between the oesophagus, aorta and spine is a better sign of invasion with an improved accuracy of 86%... 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%... Overall, the sensitivity of CT for screening for distant metastases is 41–62%, with specificity of 69–83% and accuracy of 63–90%... PET is an excellent method for screening for distant metastases and is superior to CT (see Fig. 2)... 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%)... 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