• artificial intelligence
• deep learning
• diagnosis
• early detection
• gastrointestinal cancers
• machine learning
• survival prediction
• treatment response

• Humans
• Neoadjuvant Therapy/methods
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/pathology
• Esophageal Squamous Cell Carcinoma/therapy
• Prognosis

• XXT018 the Beijing Municipal Administration of Hospitals Special Fund for Digestive System Multidisciplinary Synergic Development

• Esophageal cancer
• Gastric cancer
• Restaging
• Staging

• Humans
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/diagnosis
• Stomach Neoplasms/pathology
• Stomach Neoplasms/diagnosis
• Neoplasm Staging/methods
• Endosonography/methods

• Humans
• Adenocarcinoma
• Carcinoma, Squamous Cell
• Esophagus

• Cancer staging
• Cholangiocarcinoma
• Colorectal cancer
• Endoscopic ultrasound
• Esophageal adenocarcinoma
• Gastric cancer
• Pancreatic adenocarcinoma

• Humans
• Neoplasm Staging
• Endosonography/methods
• Gastrointestinal Neoplasms/diagnostic imaging

• PET/CT
• endoscopic ultrasound
• esophageal squamous cell carcinoma
• staging

• PET/CT
• SUV
• adenocarcinoma
• esophageal cancer
• preoperative treatment
• staging

• P30 CA008748 NCI NIH HHS

• 18-FDG PET-CT
• chemoradiotherapy
• neoadjuvant treatment
• oesophageal cancer
• predictive factors
• radiomics

• clinical information
• computed tomography
• oncological imaging
• quality assurance
• radiological report

Esophageal cancer (ECA) affects 1 in 125 men and 1 in 417 for women and accounts for 2.6% of all cancer related deaths in the United States. The associated survival rate depends on the stage of the cancer at the time of diagnosis, making adequate work up and staging imperative. The 5-year survival rate for localized disease is 46.4%, regional disease is 25.6%, and distant/metastatic disease is 5.2%. Additionally, treatment is stage-dependent, making staging all that much important. For nonmetastatic transmural tumors (T3) and/or those that have locoregional lymph node involvement (N), neoadjuvant therapy is recommended. Conversely, for those who have earlier tumors, upfront surgical resection is reasonable. While positron emission tomography/computed tomography and other cross sectional imaging modalities are exceptional for detecting distant disease, they are inaccurate in staging locoregional disease. Endoscopic ultrasound (EUS) has played a key role in the locoregional (T and N) staging of newly diagnosed ECA and has an evolving role in restaging after neoadjuvant therapy. There is even data to support that the use of EUS facilitates proper triaging of patients and may ultimately save money by avoiding unnecessary or futile treatment. This manuscript will review the current role of EUS on staging and restaging of ECA.

• Esophageal Cancer
• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Staging
• Endoscopic ultrasound

• Esophageal squamous cell carcinoma
• Multidetector computed tomography
• Tumor staging

• Fluorodeoxyglucose F18
• Gastrointestinal Neoplasms
• Humans
• Male
• Positron Emission Tomography Computed Tomography
• Positron-Emission Tomography
• Radiopharmaceuticals
• Tissue Distribution
• Tomography, X-Ray Computed

• P30 CA008748 NCI NIH HHS

• Computed tomography
• Endoscopic ultrasound
• Esophageal cancer
• FDG positron emission tomography/computed tomography
• TNM staging system

The controversy regarding optimal clinical T2N0 esophageal cancer treatment ultimately stems from the clinical staging modalities’ inaccuracy. Because most inaccuracies lie in clinical T2 to pathological T1, it is vital to discriminate whether the muscularis propria is invaded.

We investigated the association between the primary tumor maximal standard uptake value (SUVmax), and the pathological features and overall survival. We attempted to construct a discriminative model through logistic regression analysis.

A total of 140 cN0 esophageal squamous cell carcinoma (ESCC) patients were enrolled. Primary tumor SUVmax differed significantly in paired pathological T categories (P<0.05), but not pT2 vs. pT3 (P=0.648). Age (≤65 vs. >65), biopsy differentiation grades (well or moderately vs. poorly vs. unknown), and primary tumor SUVmax (continuous) were independent risk factors for invasion depth. Subsequently, the age categories, the biopsy differentiation grade categories, and the primary tumor SUVmax categories (≤7.4 vs. >7.4) were included in the logistic regression analysis to construct a discriminative model, showing a good performance in discriminating pT2–3 vs. pT1 in terms of accuracy 87.1%, sensitivity 93.6%, specificity 73.9%, and area under the curve (AUC) 0.887 [95% confidence interval (CI): 0.822 to 0.951]. Of these factors, biopsy differentiation grades and primary tumor SUVmax showed significant differences in overall survival (P<0.05), while the age categories did not.

The novel baseline model comprised of age, biopsy differentiation grades, and primary tumor SUVmax provide much discriminative performance in determining whether the muscularis propria is invaded. Further studies are necessary to validate the findings and guide clinical practice for cT2N0 esophageal cancer.

• Esophageal cancer
• invasion depth
• maximal standard uptake value (SUVmax)
• positron emission tomography with computed tomography (PET-CT)

• Esophageal neoplasms
• Medical oncology
• Neoplasm staging
• Tomography
• X-Ray computed

• Esophageal cancer
• endoscopic ultrasound
• staging

Esophageal cancer is a major cause of morbidity and mortality worldwide. Recent advancements in the management of esophageal cancer have allowed for earlier detection, improved ability to monitor progression, and superior treatment options. These innovations allow treatment teams to formulate more customized management plans and have led to an increase in patient survival rates. For example, in order for the most effective management plan to be constructed, accurate staging must be performed to determine tumor resectability. This article reviews the multimodality imaging approach involved in making a diagnosis, staging, evaluating treatment response and detecting recurrence in esophageal cancer.

• Esophageal cancer
• MRI
• endoscopic ultrasonography
• esophageal adenocarcinoma (EAC)
• esophageal squamous cell carcinoma (ESCC)

• cancer staging
• computed tomography (CT)
• esophageal and gastric cancer

• FDG-PET/CT
• cervical nodal staging
• esophageal cancer
• lymph node metastases

• Gastrointestinal
• PET/CT
• Prognosis
• Staging

The sensitivity of endoscopic ultrasound (EUS) in staging gastro-oesophageal cancers (GOCs) has been widely studied. However, the economic evidence of EUS staging in the management of patients with GOCs is scarce. This review aimed to examine all economic evidence (not limited to randomised controlled trials) of the use of EUS staging in the management of GOCs patients, and to offer a review of economic evidence on the costs, benefits (in terms of GOCs patients’ health-related quality of life), and economic implications of the use of EUS in staging GOCs patients.

The protocol was registered prospectively with PROSPERO (CRD42016043700; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016043700). MEDLINE (ovid), EMBASE (ovid), The Cochrane Collaboration Register and Library (including the British National Health Service Economic Evaluation Database), CINAHL (EBSCOhost) and Web of Science (Core Collection) as well as reference lists were systematically searched for studies conducted between 1996 and 2018 (search update 28/04/2018). Two authors independently screened the identified articles, assessed study quality, and extracted data. Study characteristics of the included articles, including incremental cost-effectiveness ratios, when available, were summarised narratively.

Of the 197 articles retrieved, six studies met the inclusion criteria: three economic studies and three economic modelling studies. Of the three economic studies, one was a cost-effectiveness analysis and two were cost analyses. Of the three economic modelling studies, one was a cost-effectiveness analysis and two were cost-minimisation analyses. Both of the cost-effectiveness analyses reported that use of EUS as an additional staging technique provided, on average, more QALYs (0.0019–0.1969 more QALYs) and saved costs (by £1969–£3364 per patient, 2017 price year) compared to staging strategy without EUS. Of the six studies, only one included GOCs participants and the other five included oesophageal cancer participants.

The data available suggest use of EUS as a complementary staging technique to other staging techniques for GOCs appears to be cost saving and offers greater QALYs. Nevertheless, future studies are necessary because the economic evidence around this EUS staging intervention for GOCs is far from robust. More health economic research and good quality data are needed to judge the economic benefits of EUS staging for GOCs.

CRD42016043700.

The online version of this article (10.1186/s12885-019-6116-0) contains supplementary material, which is available to authorized users.

• Costs
• EUS staging
• Economic review
• Effects
• Endoscopic ultrasound
• Gastro-oesophageal cancers
• QALYs
• Staging techniques

• Esophagus
• cancer
• ultrasound

We aimed to establish a risk model using computed tomography-based compactness to predict overall survival (OS) and progression-free survival (PFS) after multimodal treatment for esophageal squamous cell carcinoma (ESCC). We extracted pre-treatment computed tomography-based tumor data (volume, surface area, and compactness) for 512 cases of ESCC that were treated at 3 centers. A risk model based on compactness was trained using Cox regression analyses of data from 83 cases, and then the model was validated using two independent cohorts (98 patients and 283 patients). The largest cohort (283 patients) was then evaluated using the risk model to predict response to radiotherapy with or without chemotherapy. In the three datasets, the pre-treatment compactness risk model provided good accuracy for predicting OS (P = 0.012, P = 0.022, and P = 0.003) and PFS (P < 0.001, P = 0.003, and P = 0.005). Patients in the low-risk group did not experience a significant OS benefit from concurrent chemoradiotherapy (P = 0.099). Furthermore, after preoperative concurrent chemoradiotherapy, the OS outcomes were similar among patients in the low-risk group who did and did not achieve a pathological complete response (P = 0.127). Tumor compactness was correlated with clinical T stage but was more accurate for predicting prognosis after treatment for ESCC, based on higher C-index values in all three datasets. The compactness-based risk model was effective for predicting OS and PFS after multimodal treatment for ESCC. Therefore, it may be useful for guiding personalized treatment.

• Barrett’s esophagus
• Chromoendoscopy
• Confocal laser endomicroscopy
• Endoscopic imaging
• Esophageal adenocarcinoma
• Optical coherence tomography

• Adenocarcinoma/chemistry
• Adenocarcinoma/diagnostic imaging
• Barrett Esophagus/complications
• Barrett Esophagus/diagnostic imaging
• Biomarkers/analysis
• Esophageal Neoplasms/chemistry
• Esophageal Neoplasms/diagnostic imaging
• Esophagus/chemistry
• Esophagus/diagnostic imaging
• Gastroesophageal Reflux/complications
• Humans
• Precancerous Conditions/diagnostic imaging

• Esophageal cancer
• diagnostic imaging
• tumor staging
• tumor volume

• dysplasia
• fluorescence
• optical imaging
• spectroscopy
• targeted cancer-specific ligands

To cover the microscopic tumor spread in squamous cell carcinoma of the esophagus (SCC), longitudinal margins of 3–4 cm are used for radiotherapy (RT) protocols. However, smaller margins of 2–3 cm might be reasonable when advanced diagnostic imaging is integrated into target volume delineation. Purpose of this study was to compare the dose distribution and deposition to the organs at risk (OAR) for different longitudinal margins using a DVH- and NTCP-based approach.

Ten patients with SCC of the middle or lower third were retrospectively selected. Three planning target volumes (PTV) with longitudinal margins of 4 cm, 3 cm and 2 cm and an axial margin of 1.5 cm to the gross target volume (GTV) were defined for each patient. For each PTV two treatment plans with total doses of 41.4 Gy (neoadjuvant treatment) and 50.4 Gy (definite treatment) were calculated. Dose to the lungs, heart, myelon and liver were then evaluated and compared between different PTVs.

When using a longitudinal margin of 3 cm instead of 4 cm, all dose parameters (Dmin, Dmean, Dmedian and V5-V35), except Dmax could be significantly reduced for the lungs. Regarding the heart, a significant reduction was seen for Dmean and V5, but not for Dmin, Dmax, Dmedian and V10-V35. When comparing a longitudinal margin of 4 cm to a longitudinal margin of 2 cm, a significant difference was calculated for Dmin, Dmean, Dmedian and V5-V35 of the lungs and for Dmax, Dmean and V5-V35 of the heart. Nevertheless, no difference was seen for median heart dose. An additional dose reduction for V10 of the heart was achieved for definite treatment plans when using a longitudinal margin of 3 cm. The NTCP-based risk of pneumonitis was significantly reduced by a margin reduction to 2 cm for neoadjuvant and definite treatment plans.

Reduction of longitudinal margins from 4 cm to 3 cm can significantly reduce the dose to lungs and Dmean of the heart. Despite clinical benefit and oncologic outcome remain unclear, reduction of the longitudinal margins might provide the opportunity to reduce side effects of chemoradiation (CRT) for SCC in upcoming studies.

• Dosimetric effects
• Esophageal cancer
• Longitudinal margins
• Modern radiation techniques

The aim of this study was to establish a new preoperative staging classification and evaluate its comparability to the post-operative tumour stage, lymph node invasion and metastasis (TNM) classification. To date, adequate, preoperative staging in patients with oesophageal carcinoma (EC) is still missing but urgently needed. Systemic inflammation and disseminated tumour load have a pivotal role in recurrence and oncological outcome. To improve the clinical staging, we merged the Glasgow Prognostic Score (GPS) and disseminated tumour cells (DTC) into a new sufficient preoperative staging classification, the Hamburg-Glasgow classification (HGC).

In this prospective, single-centre study, 326 patients following curative oesophagectomy were included. From all patients preoperative bone marrow was aspirated from the iliac crest to detect DTCs by immunostaining with the pan-keratin antibody A45-B/B3. HGC was subdefined into four prognostic groups on the basis of C-reactive protein (CRP), albumin and DTC. The three prognostic groups of the GPS were supplemented by DTC detection status. Results were correlated with clinicopathological parameters and clinical outcome.

Increasing HGC significantly correlated with lymph node invasion (P=0.022), post-operative pathohistological TNM staging (P=0.001) and tumour recurrence (P=0.001). The four HGC prognostic groups displayed a gradual decrease in overall as well as disease-free survival (P<0.001, each). Hamburg-Glasgow classification was a strong, significant independent predictor of overall survival and disease-free survival (P<0.001, both) in multivariate analysis.

Hamburg-Glasgow classification seems to be a promising preoperative additive staging classification for accurate and simple outcome stratification.

• Esophageal carcinoma
• lymph node dissection
• lymphatic drainage

• 18F-FDG PET-CT
• endoscopic ultrasound
• esophageal cancer
• staging

• Computed tomography
• Endoscopic resection
• Endoscopic ultrasound
• Esophageal cancer
• Optical coherence tomography
• Positron emission tomography
• Raman spectroscopy
• Staging

• CT
• Early clinical esophageal adenocarcinoma
• Regional nodal disease
• Utility

• esophageal neoplasms
• meta-analysis
• neoadjuvant chemoradiotherapy
• positron emission tomography
• response assessment

• Biological target
• Esophageal cancer
• Positron emission tomography
• Radiotherapy

• Esophageal cancer
• Esophageal carcinoma
• PET CT
• Standardized uptake ratio
• Trimodality treatment

Accurate staging of oesophageal cancer (OC) is vital. Bibliometric analysis highlights key topics and publications that have shaped understanding of a subject. The 100 most cited articles investigating radiological staging of OC are identified.

The Thomas Reuters Web of Science database with search terms including “CT, PET, EUS, oesophageal and gastro-oesophageal junction cancer” was used to identify all English language, full-script articles. The 100 most cited articles were further analysed by topic, journal, author, year and institution.

A total of 5,500 eligible papers were returned. The most cited paper was Flamen et al. (n = 306), investigating the utility of positron emission tomography (PET) for the staging of patients with potentially operable OC. The most common research topic was accuracy of staging investigations (n = 63). The article with the highest citation rate (38.00), defined as the number of citations divided by the number of complete years published, was Tixier et al. investigating PET texture analysis to predict treatment response to neo-adjuvant chemo-radiotherapy, cited 114 times since publication in 2011.

This bibliometric analysis has identified key publications regarded as important in radiological OC staging. Articles with the highest citation rates all investigated PET imaging, suggesting this modality could be the focus of future research.

• This study identifies key articles that investigate radiological staging of oesophageal cancer.

• The most common topic was accuracy of staging investigations.

• The article with the highest citation rate investigated the use of texture analysis in PET images.

• Bibliometric analysis
• Citation
• Gastro-oesophageal junction cancer
• Oesophageal cancer
• TNM staging

• epidermal growth factor receptor
• oral cavity squamous
• paclitaxel
• tea8113

• Cancer de l’œsophage
• Esophageal cancer
• Neoadjuvant radiochemotherapy
• Nodal downstaging
• Pathological response
• Radiochimiothérapie néoadjuvante
• Régression ganglionnaire
• Régression tumorale
• Réponse histologique
• Survie
• Survival
• Tumor downstaging

• Esophageal squamous cell carcinoma
• clinical target volume
• computed tomography
• lymph node metastasis
• radiation

• Positron emission tomography (PET)
• esophageal cancer
• molecular imaging
• neoadjuvant therapy

• Esophageal cancer
• endoscopic mucosal resection (EMR)
• endoscopic submucosal dissection (ESD)
• high grade dysplasia (HGD)
• radio frequency ablation (RFA)