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


Konieczny, A. Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer. 2013, University of Zurich, Faculty of Medicine.

Abstract

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.

Abstract

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.

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Additional indexing

Item Type:Dissertation
Referees:Hodler J
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:17 Dec 2013 07:48
Last Modified:06 Aug 2017 07:15
Publisher DOI:https://doi.org/10.1007/s00330-013-2844-8

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