Qu et al [21] prospectively evaluated the use of contrast- enhanced radial VIBE sequences in the T staging of 43 patients with esophageal cancer and determined higher accuracy with MRI for T3 and T4 tumors. Malik et al [22] compared FDG-PET/CT and whole-body MRI in 49 patients, reporting similar performance for locoregional staging. Both modalities identified distant metastases that were present in 2 of the patients. Radiography Chest There is no relevant literature to support the use of chest radiography in the initial staging of patients with esophageal cancer. Variant 2: Esophageal cancer. Imaging during treatment. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with IV contrast. There is no relevant literature supporting the use of CT in patients who have undergone neoadjuvant chemoradiation. There Staging and Follow-up of Esophageal Cancer are 2 studies that discourage its use for the evaluation of tumor response. In a study investigating 39 patients, van Heijl et al [23] reported that tumor volume changes identified on CT at 14 days were not associated with histopathologic tumor response. In a study evaluating the use of CT before and after neoadjuvant therapy in 35 patients with esophageal cancer, Konieczny et al [24] determined that CT accurately predicted complete histopathologic response in 20% and overstaged in 80%. An older systematic review by Westerterp et al [25] that reviewed 4 studies with CT showed the maximum joint value for sensitivity and specificity for CT in predicting response to neoadjuvant therapy was 54%. It should be noted that another important purpose of imaging patients after neoadjuvant therapy is to evaluate for the interval development of metastases. Although there are no studies evaluating CT specifically for this purpose, it would be expected to perform similarly to initial staging.
Staging and Follow up of Esophageal Cancer. Qu et al [21] prospectively evaluated the use of contrast- enhanced radial VIBE sequences in the T staging of 43 patients with esophageal cancer and determined higher accuracy with MRI for T3 and T4 tumors. Malik et al [22] compared FDG-PET/CT and whole-body MRI in 49 patients, reporting similar performance for locoregional staging. Both modalities identified distant metastases that were present in 2 of the patients. Radiography Chest There is no relevant literature to support the use of chest radiography in the initial staging of patients with esophageal cancer. Variant 2: Esophageal cancer. Imaging during treatment. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with IV contrast. There is no relevant literature supporting the use of CT in patients who have undergone neoadjuvant chemoradiation. There Staging and Follow-up of Esophageal Cancer are 2 studies that discourage its use for the evaluation of tumor response. In a study investigating 39 patients, van Heijl et al [23] reported that tumor volume changes identified on CT at 14 days were not associated with histopathologic tumor response. In a study evaluating the use of CT before and after neoadjuvant therapy in 35 patients with esophageal cancer, Konieczny et al [24] determined that CT accurately predicted complete histopathologic response in 20% and overstaged in 80%. An older systematic review by Westerterp et al [25] that reviewed 4 studies with CT showed the maximum joint value for sensitivity and specificity for CT in predicting response to neoadjuvant therapy was 54%. It should be noted that another important purpose of imaging patients after neoadjuvant therapy is to evaluate for the interval development of metastases. Although there are no studies evaluating CT specifically for this purpose, it would be expected to perform similarly to initial staging.