Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy--systematic review.
OBJECTIVE
To compare diagnostic accuracy of computed tomography (CT), endoscopic ultrasonography (US), and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for assessment of response to neoadjuvant therapy in patients with esophageal cancer by using a systematic review of the literature.


METHODS
MEDLINE and EMBASE databases and Cochrane Database of Systematic Reviews were searched for relevant studies. Two reviewers independently assessed the methodological quality of each study. Summary receiver operating characteristic (ROC) analysis was used to summarize and compare the diagnostic accuracy of the three modalities.


RESULTS
Four studies with CT, 13 with endoscopic US, and seven with FDG PET met inclusion criteria. Percentages of the maximum score in regard to methodological quality ranged from 15% to 100%. Summary ROC analysis could be performed for three studies with CT, four with endoscopic US, and four with FDG PET. The maximum joint values for sensitivity and specificity were 54% for CT, 86% for endoscopic US, and 85% for FDG PET. Accuracy of CT was significantly lower than that of FDG PET (P < .006) and of endoscopic US (P < .003). Accuracy of FDG PET and that of endoscopic US were similar (P = .839). In all patients, CT was always feasible, whereas endoscopic US was not feasible in 6% of the patients, and FDG PET was not feasible in less than 1%.


CONCLUSIONS
CT has poor accuracy for assessment of response to neoadjuvant therapy in patients with esophageal cancer. Endoscopic US and FDG PET have equivalent good accuracy, but endoscopic US is not always feasible after chemotherapy and radiation therapy. FDG PET seems to be a promising noninvasive tool for assessment of neoadjuvant therapy in patients with esophageal cancer.
Westerterp
Marinke
M
Department of Surgery, Academic Medical Center, University of Amsterdam, Suite G4-130, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. m.westerterp@AMC.UVA.NL
van Westreenen
Henderik L
HL
Reitsma
Johannes B
JB
Hoekstra
Otto S
OS
Stoker
Jaap
J
Fockens
Paul
P
Jager
Pieter L
PL
Van Eck-Smit
Berthe L F
BL
Plukker
John T M
JT
van Lanschot
J Jan B
JJ
Sloof
Gerrit W
GW
D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18