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

Konieczny, Agnieszka ; Meyer, Philipp ; Schnider, Annelies ; Komminoth, Paul ; Schmid, Mathias ; Lombriser, Norbert ; Weishaupt, Dominik

In: European Radiology, 2013, vol. 23, no. 9, p. 2492-2502

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    Titre
    • Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer
    Auteur
    • Konieczny, Agnieszka. Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, CH-8063, Zürich, Switzerland
    • Meyer, Philipp. Department of Visceral Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
    • Schnider, Annelies. Department of Visceral Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
    • Komminoth, Paul. Institute of Pathology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
    • Schmid, Mathias. Clinic of Medical Oncology and Hematology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
    • Lombriser, Norbert. Department of Radio-Oncology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
    • Weishaupt, Dominik. Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, CH-8063, Zürich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Radiology, 2013, vol. 23, no. 9, p. 2492-2502. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:313292
    Summary
    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