Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging and Follow-up of Esophageal Cancer Discussion of Procedures by Variant Variant 1: Newly diagnosed esophageal cancer. Pretreatment clinical staging. Initial imaging. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with intravenous (IV) contrast. There is no relevant literature supporting the use of CT for evaluation of the extent of tumor extension into the esophageal wall in T1 to T3 tumors. There are, however, older studies that investigated the use of CT for the evaluation of extension into adjacent structures. Picus et al [4] reviewed CT examinations in 52 patients with esophageal carcinoma, 30 of whom had surgery or autopsy, and found that CT appearance correctly determined aortic involvement in 24 of 25 cases, with 5 indeterminate. Takashima et al [5] prospectively reviewed CT examinations on 35 patients and the reported sensitivity, specificity, and accuracy for resectability (defined as absence of evidence of invasion of adjacent structures) to be 100%, 80%, and 84%, respectively. A meta-analysis by Puli et al [6] reviewed data from 49 studies and 2,558 patients and reported pooled sensitivity and specificity of 92.4% and 97.4%, respectively, in the diagnosis of T4 disease. Unlike CT, esophageal US can also evaluate wall involvement of lower T stage tumors, with the meta-analysis by Puli et al [6] reporting sensitivity and specificity for T1 tumors of 81.6% and 99.4%, T2 tumors of 81% and 96%, and T3 tumors of 91.4% and 94.4%, respectively. There is no relevant literature supporting the use of CT for nodal staging.
Staging and Follow up of Esophageal Cancer. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging and Follow-up of Esophageal Cancer Discussion of Procedures by Variant Variant 1: Newly diagnosed esophageal cancer. Pretreatment clinical staging. Initial imaging. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with intravenous (IV) contrast. There is no relevant literature supporting the use of CT for evaluation of the extent of tumor extension into the esophageal wall in T1 to T3 tumors. There are, however, older studies that investigated the use of CT for the evaluation of extension into adjacent structures. Picus et al [4] reviewed CT examinations in 52 patients with esophageal carcinoma, 30 of whom had surgery or autopsy, and found that CT appearance correctly determined aortic involvement in 24 of 25 cases, with 5 indeterminate. Takashima et al [5] prospectively reviewed CT examinations on 35 patients and the reported sensitivity, specificity, and accuracy for resectability (defined as absence of evidence of invasion of adjacent structures) to be 100%, 80%, and 84%, respectively. A meta-analysis by Puli et al [6] reviewed data from 49 studies and 2,558 patients and reported pooled sensitivity and specificity of 92.4% and 97.4%, respectively, in the diagnosis of T4 disease. Unlike CT, esophageal US can also evaluate wall involvement of lower T stage tumors, with the meta-analysis by Puli et al [6] reporting sensitivity and specificity for T1 tumors of 81.6% and 99.4%, T2 tumors of 81% and 96%, and T3 tumors of 91.4% and 94.4%, respectively. There is no relevant literature supporting the use of CT for nodal staging.