title: Value of EUS in Determining Curative Resectability in Reference to CT and FDG-PET: The Optimal Sequence in Preoperative Staging of Esophageal Cancer?
abstract: The separate value of endoscopic ultrasonography (EUS), multidetector computed tomography (CT), and18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the optimal sequence in staging esophageal cancer has not been investigated adequately.
  
  
  
  The staging records of 216 consecutive operable patients with esophageal cancer were reviewed blindly. Different staging strategies were analyzed, and the likelihood ratio (LR) of each module was calculated conditionally on individual patient characteristics. A logistic regression approach was used to determine the most favorable staging strategy.
  
  
  
  Initial EUS results were not significantly related to the LRs of initial CT and FDG-PET results. The positive LR (LR+) of EUS-fine-needle aspiration (FNA) was 4, irrespective of CT and FDG-PET outcomes. The LR+ of FDG-PET varied from 13 (negative CT) to 6 (positive CT). The LR+ of CT ranged from 3-4 (negative FDG-PET) to 2-3 (positive FDG-PET). Age, histology, and tumor length had no significant impact on the LRs of the three diagnostic tests.
  
  
  
  This study argues in favor of PET/CT rather than EUS as a predictor of curative resectability in esophageal cancer. EUS does not correspond with either CT or FDG-PET. LRs of FDG-PET were substantially different between subgroups of negative and positive CT results and vice versa.
authors.affiliation: Department of Surgery/Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: L M A
authors.initials: LM
authors.lastname: Schreurs
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: A C J W
authors.initials: AC
authors.lastname: Janssens
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.affiliation: Department of Gastroenterology & Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Department of Gastroenterology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van Dullemen
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Groene Hart Hospital, Gouda, The Netherlands.
authors.forename: G W
authors.initials: GW
authors.lastname: Sloof
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Pruim
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Surgery/Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands. j.th.plukker@chir.umcg.nl.
authors.forename: J Th M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016013:Likelihood Functions; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D018579:Patient Selection; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D011446:Prospective Studies; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18