title: Staging and restaging of advanced esophageal cancer.
abstract: OBJECTIVE
  Esophageal cancer staging continues to evolve, especially for advanced cases. Computer tomography (CT) scan of the thorax and abdomen to detect metastatic disease, and endoscopic ultrasound with fine needle aspiration (EUS-FNA) remain the preferred methods. Several recent studies have evaluated alternative methods for locoregional and distant disease detection and staging.
  
  
  RESULTS
  There seems to be emerging roles for fluorine-18 fluorodeoxyglucose (FDG)-PET, laparoscopic staging, and high-resolution T2-weighted MRI in esophageal cancer staging. Perfusion CT and FDG-PET and FDG-PET/CT may have an emerging role in assessing response to neoadjuvant therapy. Restaging following neoadjuvant therapy remains suboptimal. A 50% or more reduction of tumor thickness by EUS postchemotherapy continues to be the best measure for tumor downstaging survival, while FDG-PET/CT may be more accurate than EUS-FNA and CT scan for predicting nodal status and complete responders after neoadjuvant therapy. Potential methylation analysis, digital image analysis, and fluorescence in-situ hybridization on EUS-FNA samples may increase the yield and prove to be better than routine cytology.
  
  
  CONCLUSIONS
  For advanced esophageal cancer, locoregional staging is best performed with EUS-FNA, with CT scan of the thorax and abdomen and FDG-PET, to detect metastatic disease. The role of EUS in restaging following neoadjuvant therapy remains controversial, with recent studies showing that FDG-PET/CT may be more accurate than EUS-FNA and CT scan for predicting nodal status and complete responders after neoadjuvant therapy.
authors.affiliation: Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Laith H
authors.initials: LH
authors.lastname: Jamil
authors.forename: Kanwar Rupinder S
authors.initials: KR
authors.lastname: Gill
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D044963:Biopsy, Fine-Needle; D003952:Diagnostic Imaging; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests