Multimodality assessment of esophageal cancer: preoperative staging and monitoring of response to therapy.

Abstract

Esophageal cancer is a leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery. Computed tomography (CT) is recommended for initial imaging following confirmation of malignancy at pathologic analysis, primarily to rule out unresectable or distant metastatic disease. With the advent of multidetector CT, use of thin sections and multiplanar reformation allows more accurate staging of esophageal cancer. Endoscopic ultrasonography (US) is the best modality for determining the depth of tumor invasion and presence of regional lymph node involvement. Combined use of fine-needle aspiration and endoscopic US can improve assessment of lymph node involvement. Positron emission tomography (PET) is useful for assessment of distant metastases but is not appropriate for detecting and staging primary tumors. PET may also be helpful in restaging after neoadjuvant therapy, since it allows identification of early response to treatment and detection of interval distant metastases. Each imaging modality has its advantages and disadvantages; therefore, CT, endoscopic US, and PET should be considered complementary modalities for preoperative staging and therapeutic monitoring of patients with esophageal cancer.

• Authors: Tae Jung Kim, Hyae Young Kim, Kyung Won Lee, Moon Soo Kim
• Journal: Radiographics : a review publication of the Radiological Society of North America, Inc (Radiographics) 2009 Mar-Apr Vol. 29 Issue 2 Pg. 403-21 ISSN: 1527-1323 [Electronic] United States
• PMID: 19325056 (Publication Type: Journal Article, Review)
• Copyright: (c) RSNA, 2009.

Topics

• Aged
• Endosonography (methods)
• Esophageal Neoplasms (diagnosis, therapy)
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Outcome Assessment, Health Care (methods)
• Positron-Emission Tomography (methods)
• Preoperative Care (methods)
• Prognosis
• Tomography, X-Ray Computed (methods)
• Treatment Outcome