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Multimodality Assessment of Esophageal Cancer: Preoperative Staging and Monitoring of Response to Therapy

2009/03/01 by Tae Jung Kim, Hyae Young Kim, Kyungwon Lee +1 · 202 citations
Medicine · #Esophageal Cancer Research and Treatment #Esophageal and GI Pathology #Gastric Cancer Management and Outcomes #Medicine #Esophageal cancer #Radiology #Malignancy #Positron emission tomography #Lymph node #Neoadjuvant therapy #Cancer #Esophagectomy #Cancer staging #Radiation therapy #Radiation treatment planning #Internal medicine #Breast cancer

paper · doi:10.1148/rg.292085106

published in Radiographics 29(2), 403-421 (Radiological Society of North America)

openalex publication_date 2009/03/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/02

Abstract

Esophageal cancer is a leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery. Computed tomography (CT) is recommended for initial imaging following confirmation of malignancy at pathologic analysis, primarily to rule out unresectable or distant metastatic disease. With the advent of multidetector CT, use of thin sections and multiplanar reformation allows more accurate staging of esophageal cancer. Endoscopic ultrasonography (US) is the best modality for determining the depth of tumor invasion and presence of regional lymph node involvement. Combined use of fine-needle aspiration and endoscopic US can improve assessment of lymph node involvement. Positron emission tomography (PET) is useful for assessment of distant metastases but is not appropriate for detecting and staging primary tumors. PET may also be helpful in restaging after neoadjuvant therapy, since it allows identification of early response to treatment and detection of interval distant metastases. Each imaging modality has its advantages and disadvantages; therefore, CT, endoscopic US, and PET should be considered complementary modalities for preoperative staging and therapeutic monitoring of patients with esophageal cancer.

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