The decision to operate: role of integrated computed tomography positron emission tomography in staging oesophageal and oesophagogastric junction cancer by the multidisciplinary team

Berrisford, Richard G.; Wong, Wei-Lup; Day, David; Toy, Elizabeth; Napier, Mark; Mitchell, Keith; Wajed, Saj
June 2008
European Journal of Cardio-Thoracic Surgery;Jun2008, Vol. 33 Issue 6, p1112
Academic Journal
Abstract: Objective: Our objective was to assess the role of fusion positron emission tomography-computed tomography (PET-CT) in staging patients for minimally invasive oesophagectomy (MIO) with potentially resectable disease from the perspective of a multidisciplinary team (MDT) deciding on operability with conventional staging investigations. Methods: Fifty consecutive patients presenting with potentially operable oesophageal or oesophagogastric junctional tumours were staged with computed tomography (CT) and endoluminal ultrasound (EUS). The MDT categorised patients as group A (n =33; CT N0M0) or group B (n =17; CT N1/possible M1). All patients underwent FDG PET-CT. Patients with localised disease (at T3), including single level N1 disease on PET-CT, were deemed suitable for induction chemotherapy followed by surgery. Results: PET-CT re-categorised 12% of patients as inoperable on grounds of distant metastases (four in group A, two in group B). Five patients did not proceed to resection for other reasons. Two had metastatic disease at thoracoscopy. Resection specimens (n =37) contained 24 nodes (median). Compared with pN status, positive predictive value of PET-CT was 40% and negative predictive value was 43%. The expected PET-CT N1 group had the highest mean number of involved nodes. Median survival for all patients (n =50) was 31.9 months for group A compared with 17.3 months for group B (not statistically significant). There was no significant difference between patients who were PET-CT N0 or N1 in survival or disease-free survival in patients undergoing surgery (n =37). Conclusions: PET-CT informs the MDT decision to operate in avoiding futile surgery in stage IV disease or widespread nodal disease. In this study, overall PET-CT N1 status has low positive and negative predictive value for overall pN status.


Related Articles

  • Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma. Bachireddy, Pavan; Tseng, Diane; Horoschak, Melissa; Chang, Daniel T.; Koong, Albert C.; Kapp, Daniel S.; Tran, Phuoc T. // Radiation Oncology;2010, Vol. 5, p105 

    Purpose: To analyze the outcomes of patients from a single institution treated with surgery and orthovoltage intraoperative radiotherapy (IORT) for pancreatic adenocarcinoma. Methods: We retrospectively reviewed 23 consecutive patients from 1990-2001 treated with IORT to 23 discrete sites with...

  • Efficient edge detection methods for diagnosis of lung cancer based on two-dimensional cellular automata. Qadir, Fasel; Peer, M. A.; Khan, K. A. // Advances in Applied Science Research;Aug2012, Vol. 3 Issue 4, p2050 

    Lung cancer is one of the most serious health problems in the world. Lung Computer-Aided Diagnosis (CAD) is a potential method to accomplish a range of quantitative tasks such as early cancer and disease detection, analysis of disease progression. The basic goal of CAD is to provide a computer...

  • Contemporary Imaging in Sarcoma. LANDA, JONATHAN; SCHWARTZ, LAWRENCE H. // Oncologist;Oct2009, Vol. 14 Issue 10, p1021 

    Sarcomas are a heterogeneous group of >50 subtypes of neoplasm. It is imperative to obtain appropriate imaging of these tumors in order to adequately assess, characterize, and stage bone and soft tissue sarcomas. Anatomic imaging such as radiographs, computed tomography, and magnetic resonance...

  • Intraductal papillary neoplasm of the bile ducts: description of MRI and added value of diffusion-weighted MRI. Yoon, Hyun; Kim, Young; Jang, Kee-Taek; Lee, Kyu; Lee, Jong; Choi, Dong; Lim, Jae // Abdominal Imaging;Oct2013, Vol. 38 Issue 5, p1082 

    Purpose: To evaluate MRI features of intraductal papillary neoplasm of the bile duct (IPNB) and to determine added value of diffusion-weighted MRI (DWI). Methods: Twenty-three patients with surgically confirmed invasive ( n = 12) and non-invasive ( n = 11) IPNB, who underwent preoperative liver...

  • Spinal epidural rhabdomyosarcoma. Rumboldt, Z.; Jednačak, H.; Talan-Hranilović, J.; Kalousek, V. // Acta Neurochirurgica;Feb2004, Vol. 146 Issue 2, p195 

    Summary We report an extremely rare case of rhabdomyosarcoma in the lower cervical and upper thoracic spine. The MR imaging appearance of the lesion was nonspecific, and different from the one previously reported. The majority of the tumor was removed surgically less than a month from the onset...

  • Nasolabial Cyst: Presentation and Management. Zahirrudin, Z.; Gendeh, B. S.; Tan, G.C.; Marina, M. B. // Internet Journal of Otorhinolaryngology;2009, Vol. 9 Issue 2, p9 

    Objective: To review our experience in managing five cases of nasolabial cyst. Design: Retrospective study. Setting: Tertiary Center, Malaysia. Subjects: Five patients, all female. Intervention: Data from patient's diagnosed as nasolabial cyst were reviewed. Main Outcome measures: Comparing the...

  • When is PET not useful in the assessment of lymphoma? O'Doherty, Michael J.; Barrington, Sally F. // European Journal of Nuclear Medicine & Molecular Imaging;2003, Vol. 30 Issue 9, p1203 

    The article focuses on the use of positron emission tomography in the assessment of lymphoma. Cure rates of greater than 80% are achieved overall in patients with Hodgkin's disease, with greater than 90% cure in favourable disease and 65% cure in less favourable disease. Therapy is tailored...

  • Reirradiation for Recurrent Neck Metastases of Head-and-Neck Tumors Using CT-Guided Interstitial 192Ir HDR Brachytherapy. Kolotas, Christos; Tselis, Nikolaos; Sommerlad, Manon; Röddiger, Sandra; Schnabel, Thomas; Baltas, Dimos; Kalogera-Fountzila, Anna; Fountzilas, George; Zamboglou, Nikolaos // Strahlentherapie und Onkologie;Feb2007, Vol. 183 Issue 2, p69 

    To report the therapeutic results obtained with CT-guided interstitial high-dose-rate brachytherapy (HDR-BRT) as exclusive treatment for recurrent neck metastases of head-and-neck tumors. Between 1995 and 1999, 49 patients with prior radiation therapy (RT) with or without surgery for primary...

  • Role of surgery in multidisciplinary treatment for solid cancers. Sasako, Mitsuru // International Journal of Clinical Oncology;Oct2004, Vol. 9 Issue 5, p346 

    In the evolution of solid cancer, there are four steps: noninvasive tumor, local invasive cancer without metastasis, local invasive cancer with lymph node metastasis, and eventually systemic disease. For the first three phases, local treatment, including lymph node dissection, may cure the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics