New TNM staging system for esophageal cancer: what chest radiologists need to know.

Esophageal cancer is a leading cause of cancer-related deaths worldwide, and the 5-year relative survival rate remains less than 20% in the United States. The treatment of esophageal cancer should be stage specific for better clinical outcomes. Recent treatment paradigms tend to involve a multimodality approach to management, which includes surgical resection and preoperative or definitive chemoradiation therapy. Accurate pretreatment staging of esophageal cancer is integral for assessing operability and determining a suitable treatment plan. The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) have published the seventh edition of the staging manual for cancer in the esophagus and esophagogastric junction. Unlike the sixth edition, the revised staging manual is data driven and harmonized with the staging of stomach cancer. Improvements include new definitions for the anatomic classifications Tis, T4, regional lymph node, N, and M and the addition of nonanatomic cancer characteristics (histopathologic cell type, histologic grade, and cancer location). Given the recent increase in the incidence of adenocarcinoma of the distal esophagus, esophagogastric junction, and gastric cardia, the staging of tumors in the esophagogastric junction has been addressed. Radiologists must understand the details of the seventh edition of the AJCC-UICC staging system for esophageal cancer and use appropriate imaging modalities, such as computed tomography (CT), endoscopic ultrasonography, and positron emission tomography/CT, for initial staging.

Long-Term Follow-Up Results From PET/CT Surveillance After Surgical Resection of Lung Adenocarcinoma Manifesting as Ground-Glass Opacity.

The purpose of our study was to retrospectively evaluate the value of F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for postoperative surveillance of lung adenocarcinoma manifesting as ground-glass opacity (GGO).From May 2003 to December 2007, 111 patients with surgically resected lung adenocarcinoma manifesting as GGO were included. Clinical findings of recurrence and survival, CT features, and maximum standardized uptake value (SUVmax) were reviewed and compared among 3 groups according to GGO proportion: Group I, GGO 100%; Group II, GGO ≥50%; Group III, GGO < 50%. Disease-free survival (DFS) was estimated using the Kaplan-Meier method. Diagnostic performances of CT and PET/CT for recurrence were compared during a long-term follow-up period of >5 years.Recurrence was identified in Group III (18 of 53, 34%) but not in Groups I (n = 25) or II (n = 33) over a mean follow-up period of 74 months. Group showed significant differences in GGO proportion, SUVmax, and DFS duration (P < 0.001). PET/CT led to 6 false-positive and 5 false-negative interpretations of recurrence. For surveillance CT, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.4%, 98.6%, 98.2%, 94.4%, and 98.9%, respectively; for PET/CT, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 72.2%, 92.3%, 88.5%, 68.4%, and 93.5%, respectively. CT showed significantly higher accuracy than PET/CT (P = 0.0188).FDG-PET/CT showed no clear advantage for postoperative surveillance of lung cancer with predominant GGO because of low incidence of recurrence and frequent false-positive and false-negative results.