Radiography Chest There is no relevant literature to support the use of chest radiography during treatment. Variant 3: Esophageal cancer. Posttreatment imaging. No suspected or known recurrence. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with IV contrast. CT has been studied in the evaluation of patients who have completed treatment. Recent data exist from studies comparing FDG-PET and FDG-PET/CT with contrast-enhanced CT in the detection of recurrence. Kato et al [38] studied 55 patients and reported 89% sensitivity, 79% specificity, and 84% accuracy for CT in detecting recurrent disease in comparison with 96% sensitivity, 68% specificity, and 82% accuracy for FDG-PET. The authors did note that CT was more sensitive than FDG-PET for the detection of lung metastases. Teyton et al [39] prospectively studied 41 patients postsurgery for esophageal cancer and reported 65% sensitivity and 91% specificity for chest and abdomen CT versus 100% sensitivity and 85% specificity for FDG-PET. Of note, in a retrospective review by Antonowicz et al [40], 169 patients who underwent esophagectomy and were followed with annual CT had no change in management or survival. CT Chest, Abdomen, and Pelvis There are no specific studies comparing body CT scans that include the pelvis with those that do not in asymptomatic patients undergoing CT to evaluate for recurrent disease. FDG-PET/CT Skull Base to Mid-Thigh Several studies have evaluated FDG-PET/CT in the evaluation of asymptomatic patients who have had definitive treatment for esophageal cancer. Betancourt et al [41] studied 162 asymptomatic patients who underwent surgery for esophageal cancer and were followed with FDG-PET/CT. They reported a sensitivity of 77% and specificity of 76% for recurrence at the anastomosis, sensitivity of 88% and specificity of 85% for regional node recurrence, and sensitivity of 97% and specificity of 96% for distant metastases.
Staging and Follow up of Esophageal Cancer. Radiography Chest There is no relevant literature to support the use of chest radiography during treatment. Variant 3: Esophageal cancer. Posttreatment imaging. No suspected or known recurrence. CT Chest and Abdomen For the purposes of this document, CT examinations are considered as being performed with IV contrast. CT has been studied in the evaluation of patients who have completed treatment. Recent data exist from studies comparing FDG-PET and FDG-PET/CT with contrast-enhanced CT in the detection of recurrence. Kato et al [38] studied 55 patients and reported 89% sensitivity, 79% specificity, and 84% accuracy for CT in detecting recurrent disease in comparison with 96% sensitivity, 68% specificity, and 82% accuracy for FDG-PET. The authors did note that CT was more sensitive than FDG-PET for the detection of lung metastases. Teyton et al [39] prospectively studied 41 patients postsurgery for esophageal cancer and reported 65% sensitivity and 91% specificity for chest and abdomen CT versus 100% sensitivity and 85% specificity for FDG-PET. Of note, in a retrospective review by Antonowicz et al [40], 169 patients who underwent esophagectomy and were followed with annual CT had no change in management or survival. CT Chest, Abdomen, and Pelvis There are no specific studies comparing body CT scans that include the pelvis with those that do not in asymptomatic patients undergoing CT to evaluate for recurrent disease. FDG-PET/CT Skull Base to Mid-Thigh Several studies have evaluated FDG-PET/CT in the evaluation of asymptomatic patients who have had definitive treatment for esophageal cancer. Betancourt et al [41] studied 162 asymptomatic patients who underwent surgery for esophageal cancer and were followed with FDG-PET/CT. They reported a sensitivity of 77% and specificity of 76% for recurrence at the anastomosis, sensitivity of 88% and specificity of 85% for regional node recurrence, and sensitivity of 97% and specificity of 96% for distant metastases.