Role of high-resolution magnetic resonance imaging in preoperative tumor-node-metastasis staging evaluation of esophageal cancer: a narrative review.

BACKGROUND AND OBJECTIVE

Esophageal cancer (EC) is an aggressive disease characterized by high mortality rates and a propensity for locoregional or distant recurrence. The treatment strategies and prognostic estimation for EC depend on accurate pre-treatment tumor-node-metastasis (TNM) staging. The objective of this review was to illustrate the role of various imaging modalities in achieving accurate preoperative TNM staging of EC, with a particular focus on the utilization of advanced high-resolution magnetic resonance imaging (MRI) sequences for T classification, which have shown promise in enhancing the delineation of tumor depth and extent.

METHODS

A comprehensive literature search was conducted in PubMed and Web of Science databases. The studies on imaging in preoperative TNM staging of EC published in English from inception of these databases to December 31, 2022 were reviewed.

KEY CONTENT AND FINDINGS

The review highlights the distinct advantages and inherent limitations of different imaging modalities for the preoperative staging of EC. Endoscopic ultrasound (EUS) provides real-time, high-resolution imaging of the esophageal wall but is operator-dependent. Computed tomography (CT) is widely available and non-invasive, but it may lack sensitivity for early T-stage identification. Positron emission tomography (PET)/CT offers accurate assessment of distant metastasis but has limited value in the evaluation of early-stage tumors. With improved techniques, MRI is particularly useful for visualization of tumor infiltration and the surrounding anatomical structures, gaining prominence in preoperative staging of EC.

CONCLUSIONS

Various imaging modalities including EUS, CT, PET/CT, and MRI should be applied as complementary methods for preoperative TNM staging of EC. Notably, high-resolution MRI can overcome motion-related artifacts and provide high-quality images, which may play a more important role in the management of EC in the future.