Oda Shioto, Kuno Hirofumi, Fujita Takeo, Hiyama Takashi, Kotani Daisuke, Kadota Tomohiro, Sakashita Shingo, Kobayashi Tatsushi
Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Jpn J Radiol. 2025 Mar;43(3):434-444. doi: 10.1007/s11604-024-01678-1. Epub 2024 Oct 19.
This study aimed to evaluate the clinical significance of four-dimensional dynamic ventilation CT (4DCT) for assessing resectability in borderline resectable locally advanced esophageal cancer (BR-LAEC) and confirmed the pathological validity of the 4DCT results in surgery without prior treatment.
We retrospectively reviewed 128 patients (107 men; median age, 68 [range, 43-89] years) diagnosed with BR-LAEC on initial conventional CT (i-CT). These patients were initially classified into three categories: BR1 (closer to resectable), BR2 (resectability not assessable), or BR3 (closer to unresectable). Subsequent 4DCT reclassified patients as either resectable or unresectable within 1 week of i-CT. We analyzed the diagnostic shift induced by 4DCT. Additionally, 18 patients who underwent surgery without prior treatment were evaluated using 4DCT and pathological outcomes.
4DCT reclassified patients with BR-LAEC as resectable (57.0%; 73/128) and unresectable (43.0%; 55/128). Of 53 patients initially classified as BR1, 32.1% (17/53) were reclassified as unresectable, and of 47 patients initially classified as BR3, 46.8% (22/47) were reclassified as resectable. Among 28 patients initially classified as BR2, 53.6% (15/27) were reclassified as resectable and 46.4% (13/27) as unresectable. In the surgery-only cohort of 18 patients, 9 were initially classified as BR1 and 9 as BR2, and all were reclassified as resectable. These patients were pathologically confirmed to have resectable disease.
4DCT may provide information complementary to that provided by initial conventional CT in assessing resectability among patients with BR-LAEC, and could be a useful adjunct tool for guiding clinical decisions in this patient population.
本研究旨在评估四维动态通气CT（4DCT）在评估可切除性边缘的局部晚期食管癌（BR-LAEC）中的临床意义，并在未经术前治疗的手术中证实4DCT结果的病理有效性。
我们回顾性分析了128例患者（107例男性；中位年龄68岁[范围43-89岁]），这些患者在初次常规CT（i-CT）上被诊断为BR-LAEC。这些患者最初被分为三类：BR1（更接近可切除）、BR2（可切除性无法评估）或BR3（更接近不可切除）。随后的4DCT在i-CT后1周内将患者重新分类为可切除或不可切除。我们分析了4DCT引起的诊断变化。此外，对18例未经术前治疗即接受手术的患者进行了4DCT和病理结果评估。
4DCT将BR-LAEC患者重新分类为可切除（57.0%；73/128）和不可切除（43.0%；55/128）。最初分类为BR1的53例患者中，32.1%（17/53）被重新分类为不可切除，最初分类为BR3的47例患者中，46.8%（22/47）被重新分类为可切除。最初分类为BR2的28例患者中，53.6%（15/27）被重新分类为可切除，46.4%（13/27）被重新分类为不可切除。在18例仅接受手术的患者队列中，9例最初分类为BR1，9例最初分类为BR2，所有患者均被重新分类为可切除。这些患者经病理证实患有可切除疾病。
4DCT在评估BR-LAEC患者的可切除性方面可能提供与初次常规CT互补的信息，并且可能是指导该患者群体临床决策的有用辅助工具。
