Skip to main content

Advertisement

SpringerLink
Log in

Esophageal wall thickness on CT scans: can it predict the T stage of primary thoracic esophageal squamous cell carcinoma?

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

CT is the most commonly used method to stage esophageal cancer (EC). However, the reported CT T-staging criteria for EC are controversial.

Purpose

To determine and validate the optimal esophageal wall thickness (EWT) threshold on CT to distinguish lesions with different T stages in esophageal squamous cell carcinoma (ESCC) patients.

Methods

One thousand, one hundred-two consecutive patients with histopathologically confirmed ESCC between July 2014 and April 2020 were retrospectively reviewed. All patients underwent a preoperative CT examination and surgical treatment. The maximal EWT of the lesions on CT was measured. Patients were divided into pT1, pT2, pT3 and pT4 subgroups according to the pathologic stage. We employed the support vector machine, where linear kernels were leveraged to determine the optimal threshold to classify samples with different T stages. 90% of samples from each subgroup were randomly selected as the training set, while the remainder comprised the testing set.

Results

The mean EWTs of the pT1, pT2, pT3 and pT4 subgroups were 4.9 ± 2.6 mm, 8.1 ± 2.3 mm, 12.4 ± 3.6 mm, and 18.6 ± 4.4 mm, respectively. Differences in the EWT between the four subgroups or between adjacent subgroups were significant (p < 0.001), and esophageal wall became thicker with increasing pT stage. We utilized MATLAB 2020a to implement the SVM model and ran the code 10 times. The accuracy of the model was 60.29 ± 2.33%. The thresholds between samples from pT1/pT2, pT2/pT3 and pT3/pT4 lesions were 5.5 ± 0.3 mm, 10.8 ± 0.8 mm and 15.9 ± 0.5 mm, respectively.

Conclusions

Possibility of predicting T stage of ESCC by EWT on CT scans was limited to 60% by model examination with large sample size.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

EC:

Esophageal cancer

ESCC:

Esophageal squamous cell carcinoma

EWT:

Esophageal wall thickness

SVM:

Support vector machine

EUS:

Endoscopic ultrasound

AJCC:

American Joint Committee on Cancer

PACS:

Picture archiving and communication system

ANOVA:

Analysis of variance

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin. 2018;68(6):394–424.

    Article  Google Scholar 

  2. Lee H-S, Jung H-K, Tae CH, et al. Treatment pattern and overall survival in esophageal cancer during a 13-year period: a nationwide cohort study of 6,354 Korean patients. PLoS ONE. 2020;15(4):e0231456.

    Article  PubMed  Google Scholar 

  3. Cai Z, Liu Q. Understanding the Global Cancer Statistics 2018: implications for cancer control. Sci China Life Sci. 2021;64(6):1017–20.

    Article  Google Scholar 

  4. Li B, Li N, Liu S, et al. Does [18F] fluorodeoxyglucose–positron emission tomography/computed tomography have a role in cervical nodal staging for esophageal squamous cell carcinoma? J Thorac Cardiovasc Surg. 2020;160(2):544–50.

    Article  Google Scholar 

  5. Krill T, Baliss M, Roark R, et al. Accuracy of endoscopic ultrasound in esophageal cancer staging. J Thorac Dis. 2019;11(S12):S1602–9.

    Article  PubMed  Google Scholar 

  6. Choi J, Kim SG, Kim JS, et al. Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer. Surg Endosc. 2010;24(6):1380–6.

    Article  Google Scholar 

  7. Deng J, Chu X, Ren Z, et al. Relationship between T stage and survival in distantly metastatic esophageal cancer: A STROBE-compliant study. Medicine. 2020;99(19):e20064.

    Article  CAS  PubMed  Google Scholar 

  8. He LJ, Xie C, Wang ZX, et al. Submucosal saline injection followed by endoscopic ultrasound versus endoscopic ultrasound only for distinguishing between T1a and T1b esophageal cancer. Clin Cancer Res. 2020;26(2):384–90.

    Article  CAS  Google Scholar 

  9. Lee G, I H, Kim SJ, , et al. Clinical implication of PET/MR imaging in preoperative esophageal cancer staging: comparison with PET/CT, endoscopic ultrasonography, and CT. J Nucl Med. 2014;55(8):1242–7.

    Article  Google Scholar 

  10. Sandha GS, Severin D, Postema E, et al. Is positron emission tomography useful in locoregional staging of esophageal cancer? Results of a multidisciplinary initiative comparing CT, positron emission tomography, and EUS. Gastrointest Endosc. 2008;67(3):402–9.

    Article  Google Scholar 

  11. Pfau PR, Perlman SB, Stanko P, et al. The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography. Gastrointest Endosc. 2007;65(3):377–84.

    Article  Google Scholar 

  12. Iyer RB, Silverman PM, Tamm EP, et al. Diagnosis, staging, and follow-up of esophageal cancer. AJR Am J Roentgenol. 2003;181(3):785–93.

    Article  Google Scholar 

  13. Wu LF, Wang BZ, Feng JL, et al. Preoperative TN staging of esophageal cancer: comparison of miniprobe ultrasonography, spiral CT and MRI. World J Gastroenterol. 2003;9(2):219–24.

    Article  PubMed  Google Scholar 

  14. Chen M, Li X, Chen Y, et al. Proposed revision of the 8th edition AJCC clinical staging system for esophageal squamous cell cancer treated with definitive chemo-IMRT based on CT imaging. Radiat Oncol. 2019;14(1):54.

    Article  PubMed  Google Scholar 

  15. Cheng ZZ, Yang NJ, Xi XQ, et al. Diagnostic and application value of 64-slice spiral CT scanning in preoperative staging of esophageal cancer. Zhonghua Zhong Liu Za Zhi. 2011;33(12):929–32.

    Google Scholar 

  16. Moschetta M, Ianora AA, Marzullo A, et al. Vessel probe CT protocol in the study of esophageal carcinoma: can it improve preoperative T staging? Eur J Surg Oncol. 2010;36(7):663–9.

    Article  CAS  Google Scholar 

  17. Lowe VJ, Booya F, Fletcher JG, et al. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol. 2005;7(6):422–30.

    Article  Google Scholar 

  18. Botet JF, Lightdale CJ, Zauber AG, et al. Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT. Radiology. 1991;181(2):419–25.

    Article  CAS  PubMed  Google Scholar 

  19. Moss AA, Schnyder P, Thoeni RF, et al. Esophageal carcinoma: pretherapy staging by computed tomography. Am J Roentgenol. 1981;136(6):1051–6.

    Article  CAS  Google Scholar 

  20. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12(1):36–42.

    Article  Google Scholar 

  21. Hu CY, Li YK, Li JB, et al. A comparative study of the normal oesophageal wall thickness based on 3-dimensional, 4-dimensional, and cone beam computed tomography. Medicine. 2020;99(45):e22553.

    Article  CAS  PubMed  Google Scholar 

  22. Panebianco V, Grazhdani H, Iafrate F, et al. 3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging? Eur Radiol. 2006;16(2):414–21.

    Article  CAS  Google Scholar 

  23. Yamabe Y, Kuroki Y, Ishikawa T, et al. Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT. AJR Am J Roentgenol. 2008;191(3):753–7.

    Article  Google Scholar 

  24. Thompson WM, Halvorsen RA Jr. Staging esophageal carcinoma II: CT and MRI. Semin Oncol. 1994;21(4):447–52.

    CAS  Google Scholar 

  25. Picus D, Balfe DM, Koehler RE, et al. Computed tomography in the staging of esophageal carcinoma. Radiology. 1983;146(2):433–8.

    Article  CAS  Google Scholar 

  26. Umeoka S, Koyama T, Watanabe G, et al. Preoperative local staging of esophageal carcinoma using dual-phase contrast-enhanced imaging with multi-detector row computed tomography: value of the arterial phase images. J Comput Assist Tomogr. 2010;34(3):406–12.

    Article  Google Scholar 

  27. Sultan R, Haider Z, Chawla TU. Diagnostic accuracy of CT scan in staging resectable esophageal cancer. J Pak Med Assoc. 2016;66(1):90–2.

    Google Scholar 

  28. Walker AJ, Spier BJ, Perlman SB, et al. Integrated PET/CT fusion imaging and endoscopic ultrasound in the pre-operative staging and evaluation of esophageal cancer. Mol Imaging Biol. 2011;13(1):166–71.

    Article  Google Scholar 

Download references

Acknowledgements

This study is supported by the Natural Science Foundation of Shandong Province (ZR2019PH115).

Author information

Author notes

  1. Jin-zhi Wang and Qing Wang are co-corresponding authors.

Authors and Affiliations

  1. Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No.107 Wenhuaxi Road, Jinan, 250012, Shandong, China

    Yue Wang & Qing Wang

  2. Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440 Jiyan Road, Jinan, 250117, Shandong, China

    Yue Wang, Yong Huang, Qi-yu Zhao, Xiao-qin Li & Ling Wang

  3. Department of Radiology, Zibo Prevention and Treatment Hospital for Occupation Diseases, No.121 Nanjing Road, Zibo, 255000, Shandong, China

    Ning-ning Wang

  4. Department of Radiation Oncology (Chest Section), Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440 Jiyan Road, Jinan, 250117, Shandong, China

    Jin-zhi Wang

Authors
  1. Yue Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qi-yu Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiao-qin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ning-ning Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin-zhi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Qing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jin-zhi Wang or Qing Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no confict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Formal consent is not required for this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Huang, Y., Zhao, Qy. et al. Esophageal wall thickness on CT scans: can it predict the T stage of primary thoracic esophageal squamous cell carcinoma?. Esophagus 19, 269–277 (2022). https://doi.org/10.1007/s10388-021-00886-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-021-00886-2

Keywords

Search

Navigation