Objective: To construct the diagnostic model of superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in endoscopic images based on the YOLOv5l model by using deep learning method of artificial intelligence to improve the diagnosis of early ESCC and precancerous lesions under endoscopy. Methods: 13, 009 endoscopic esophageal images of white light imaging (WLI), narrow band imaging (NBI) and lugol chromoendoscopy (LCE) were collected from June 2019 to July 2021 from 1, 126 patients at the Cancer Hospital, Chinese Academy of Medical Sciences, including low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, ESCC limited to the mucosal layer, benign esophageal lesions and normal esophagus. By computerized random function method, the images were divided into a training set (11, 547 images from 1, 025 patients) and a validation set (1, 462 images from 101 patients). The YOLOv5l model was trained and constructed with the training set, and the model was validated with the validation set, while the validation set was diagnosed by two senior and two junior endoscopists, respectively, to compare the diagnostic results of YOLOv5l model and those of the endoscopists. Results: In the validation set, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the YOLOv5l model in diagnosing early ESCC and precancerous lesions in the WLI, NBI and LCE modes were 96.9%, 87.9%, 98.3%, 88.8%, 98.1%, and 98.6%, 89.3%, 99.5%, 94.4%, 98.2%, and 93.0%, 77.5%, 98.0%, 92.6%, 93.1%, respectively. The accuracy in the NBI model was higher than that in the WLI model (P<0.05) and lower than that in the LCE model (P<0.05). The diagnostic accuracies of YOLOv5l model in the WLI, NBI and LCE modes for the early ESCC and precancerous lesions were similar to those of the 2 senior endoscopists (96.9%, 98.8%, 94.3%, and 97.5%, 99.6%, 91.9%, respectively; P>0.05), but significantly higher than those of the 2 junior endoscopists (84.7%, 92.9%, 81.6% and 88.3%, 91.9%, 81.2%, respectively; P<0.05). Conclusion: The constructed YOLOv5l model has high accuracy in diagnosing early ESCC and precancerous lesions in endoscopic WLI, NBI and LCE modes, which can assist junior endoscopists to improve diagnosis and reduce missed diagnoses.
Artificial Intelligence ; Endoscopy/methods* ; Esophageal Neoplasms/pathology* ; Esophageal Squamous Cell Carcinoma/diagnostic imaging* ; Humans ; Narrow Band Imaging ; Precancerous Conditions/diagnostic imaging* ; Sensitivity and Specificity

Objective To assess the diagnostic accuracy of multidetector CT (MDCT) for restaging of patients with esophageal squamous cell carcinoma (SCC) after neoadjuvant chemotherapy and determine the feasibility of CT for assessing the treatment response and evaluating the prognosis. Methods Totally 135 patients with esophageal SCC who had received neoadjuvant treatment and surgery in Beijing Cancer Hospital from September 2005 to December 2011 were enrolled in this study. TN staging was performed using CT for lesions before and after neoadjuvant treatment by two radiologists,and the tumor regression grade (TRG) and pathological TRG were also assessed. Based on preoperative CT TN restaging results,the patients were defined as responders with TNafter therapy,non-responders with T3-4N+,and patients with undefined response (TN0 or TNN). Results The accuracy of T and N restaging using CT was 50%,54% (κ=0.718,P <0.001) and 59%,56% (κ=0.753,P <0.001) by two radiologists,respectively. TRG from CT was predicted correctly in 27% of patients. Pathological TRG was an accurate predictor of survival (χ=8.13,P=0.04). There was no significant trend toward better survival for lower CT TRG (χ=1.17,P=0.286). Among 135 patients with esophageal cancer,19 patients(14.07%) were responders ,46 patients(34.07%) were non-responders,and 70 patients (50.37%)were patients with undefined response . The overall survival rates of responders,non-responders and patients with undefined response were 71.5%,47.3%,and 18.5%,respectively. The overall survival of responders was better than that of patients with undefined response (χ=1.518,P=0.63) and non-responders(χ=12.04,P=0.0016),but the overall survival of patients with undefined response was better than that of non-responders (χ=14.468,P=0.0003). Conclusion sMDCT restaging after neoadjuvant treatment can not accurately predict pathological stage in esophageal SCC. The CT T and N restaging has certain clinical value in assessing the response to neoadjuvant chemotherapy in patients with esophageal cancer and predicting the prognosis.
Carcinoma, Squamous Cell ; diagnostic imaging ; drug therapy ; Esophageal Neoplasms ; diagnostic imaging ; drug therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Survival Rate ; Tomography, X-Ray Computed

OBJECTIVEUsing the volume calculating function of treatment planning system of 3DCRT to work out the value of GTV standard classifications and to provide the reference for clinical staging of esophageal carcinoma.

METHODSSix hundred and seven patients underwent radical resection of thoracic esophageal carcinoma in our hospital, and their pre-operative CT images were transmitted in digital format to the three-dimensional conformal radiotherapy planning system by the network. Esophageal lesion GTV targets were outlined, and their volumes were automatically computed by the planning system. Compared the differences of the GTV volumes in different pathological T stages, and analyzed the relationship between GTV volumes and pathological T stages. According to the median volume of GTV at different pathological T stages, divided the values of GTV volume corresponding to different T stages and selected the suitable classification standard of GTV volume.

RESULTSThe esophageal carcinoma GTV length, maximum diameter and volume were related to pathological T staging and with a positive correlation (all P < 0.001). The Spearman correlation coefficient (r) was 0.376, 0.466 and 0.464, respectively, P < 0.001. Except that the length, maximum diameter and volume of GTV in pathological T3 and T4 had no significant difference, other indicators of the pathological T stages showed significant differences between the groups (P < 0.001). According to the median volume of GTV at different pathological T stages, the GTV volumes were divided into three grades: 13.0 cm(3). When compared them with pathological T1, T2, and T3-T4 stages, the coincidence rate was 73.8%. The consistency was good between the GTV volume grades and pathological T stages (Kappa = 0.40, P < 0.001). The overall 5-year survival rates of GTV grades 1, 2, 3 were 78.1%, 31.5% and 33.5%, respectively (P < 0.0001). If the GTVs were divided into four grades: 39.0 cm(3), the coincidence rate of GTV volume grades and pathology T staging was only 54.7%, and the consistency was poor, Kappa = 0.24, P < 0.001. The overall 5-year survival rate of GTV 1, 2, 3, 4 were 78.1%, 31.5%, 36.2% and 27.5%, respectively (P < 0.0001).

CONCLUSIONThe length, maximum diameter and volume of esophageal carcinoma GTV are related to pathological T staging with a positive correlation. The classification that esophageal carcinoma GTVs divided into three grades has a good coincidence with the pathological T staging.

Adult ; Aged ; Carcinoma, Small Cell ; diagnostic imaging ; surgery ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Survival Rate ; Tomography, X-Ray Computed ; Tumor Burden

The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer. Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression. Positron emission tomography combined with computed tomography (PET/CT) is becoming an important tool in the workup of esophageal carcinoma. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) in assessing lymph node metastasis in esophageal squamous cell carcinoma (ESCC) prior to surgery. Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied. These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes. They all had (18)F-FDG PET/CT scans in their preoperative staging procedures. None had a prior history of cancer. The pathologic status and PET/CT SUVmax of lymph nodes were collected to calculate the receiver operating characteristic (ROC) curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes. Lymph node data from 27 others were used for the validation. A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort, and 117 lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort. The cutoff point of the SUVmax for lymph nodes was 4.1, as calculated by ROC curve (sensitivity, 80%; specificity, 92%; accuracy, 90%). When this cutoff value was applied to the validation cohort, a sensitivity, a specificity, and an accuracy of 81%, 88%, and 86%, respectively, were obtained. These results suggest that the SUVmax of lymph nodes predicts malignancy. Indeed, when an SUVmax of 4.1 was used instead of 2.5, FDG-PET/CT was more accurate in assessing nodal metastasis.
Carcinoma, Squamous Cell ; diagnostic imaging ; Esophageal Neoplasms ; diagnostic imaging ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Multimodal Imaging ; methods ; Positron-Emission Tomography ; Radiopharmaceuticals ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo investigate the diagnostic and application value of pre-operative 64-slice spiral CT evaluation in operation selection for esophagus cancer.

METHODSMulti-slice computed tomography (MSCT) was conducted in 50 patients with esophageal cancer before operation, using the work station for after-treatment to get CT virtual endoscopy (CTVE), multiplanar reconstruction (MRP), shaded surface display (SSD) and Raysum images, and combined with the transect images to record the preoperative MSCT staging and to predict the operation scheme, and compared with the postoperative pathological staging and the actual operational plan.

RESULTSThe diagnostic sensitivity of MSCT for preoperative T staging was 100.0% (50/50), while the N staging was 80.0% (16/20). According to the MSCT prediction, the resection rate of esophageal cancer was 96.0% (48/50). Through the preoperative MSCT evaluation, the accuracy of CT-TNM stage was 90.0%, highly consistent with the pathological TNM stage (Kappa = 0.811, P < 0.05).

CONCLUSIONSMSCT can effectively display the shape, size and position of the tumor, determine the tumor invasion range, lymph node metastasis and distant metastasis, etc., make preoperative evaluation for esophagus cancer patients and provide evidence for clinicians to predict the operation scheme for esophagus cancer.

Adenocarcinoma ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multidetector Computed Tomography ; Neoplasm Staging ; methods ; Preoperative Period ; Young Adult

OBJECTIVETo evaluate the accuracy of radiographic examination, endoscopic examination and clinical response evaluation criteria in staging for esophageal carcinoma after preoperative chemoradiation therapy(pre-CRT).

METHODSTwenty-seven patients of locally advanced esophageal squamous cell carcinoma were involved. CT scan for cervical part, chest and abdomen, and endoscopic ultrasound(EUS), electronic fibrobroncoscopic examination were used to assess the tumor for staging before pre-CRT. The tumors were re-assessed using the same methods after the completion of CRT. Response evaluation criteria in solid tumors(RECIST) was used to assess the tumor response. Surgery was carried out 3 to 6 weeks after CRT. The clinical tumor response before surgery was compared with pathological tumor response after surgery. Micrometastasis detection was carried out for paraffin embedded lymph nodes using anti-keratin monoclonal marker AE1 and AE3 by immunohistochemical(IHC) method.

RESULTSThe accuracy of CT scan in staging after pre-CRT was 40.9%(9/22) for primary tumors and 68.2%(15/22)for lymph nodes, with overall accuracy of 40.9%(9/22) for TNM staging. The accuracy of EUS in staging was 38.5%(5/13) for primary tumors and 69.2%(9/13) for lymph nodes, with overall accuracy of 38.5%(5/13)for TNM staging. While CT scan combined with EUS, the accuracy for TNM staging was 46.2%(6/13). Five cases achieved CR, 14 cases achieved PR and 8 cases achieved SD according to RECIST. Among 5 clinical CR cases, 3 cases were confirmed by pathologic examination, 1 case was diagnosed as pT(3)N(1) disease by HE stain. One case with pT(0)N(0) disease by HE stain was detected with lymph node micrometastasis by IHC. Among 5 pathological CR cases, 3 cases were diagnosed as clinical CR, 2 cases were diagnosed as clinical PR before surgery. Among 15 cases of N(0) disease by HE stain, 3 lymph nodes from 2 cases were detected with micrometastasis by IHC.

CONCLUSIONSThe current examinations(barium swallow, CT scan,EUS, endoscopy guided biopsy) and RECIST are not accurate enough to assess the tumor response for esophageal squamous cell carcinoma after pre-CRT. Surgery should be recommended for patients with clinical CR after pre-CRT.

Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; therapy ; Chemotherapy, Adjuvant ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Radiography ; Radiotherapy, Adjuvant ; Treatment Outcome

OBJECTIVETo investigate the correlation between 18F-fluorodeoxyglucose (18FDG) uptake of primary lesions during PET-CT (positron emission tomography and computed tomography) examination and clinicopathological parameters such as the tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status in the patients with esophageal carcinoma.

METHODSFrom June 2004 to November 2006, 68 operable esophageal carcinoma patients were enrolled into this study, and all had a whole body 18FDG PET-CT scan before operation. The maximum standardized uptake value (SUVmax) of the primary lesions was measured. The tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status were determined by postoperative pathological examination. The correlation between the standardized uptake value (SUV) of primary lesions and the above mentioned clinicopathological parameters was analyzed.

RESULTSThe overall length of primary lesion was positively correlated with SUVmax (r=0.512, P=0.01). Depth of invasion was also positively correlated with SUVmax (r=0.860, P=0.000). There was a statistically significant difference in SUVmax between poorly differentiated group and moderately or well differentiated group (r=0.781, P=0.000), and also between the groups with or without lymph node metastasis (r=0.852, P=0.000).

CONCLUSIONThe tumor length, depth of invasion and differentiation of the primary lesions of the esophageal carcinoma are all positively correlated with maximum standardized uptake value of 18FDG. The more poorly differentiated lesions show a higher 18FDG maximum standardized uptake value. The lesions with lymph node metastasis have also a significantly higher 18FDG maximum standardized uptake value than those without lymph node metastases.

Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; metabolism ; pathology ; Esophageal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Female ; Fluorodeoxyglucose F18 ; metabolism ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; metabolism ; Tomography, X-Ray Computed ; Tumor Burden

OBJECTIVETo explore whether there is a relationship between gross tumor volume (GTV) and pathologic lymph node metastasis or prognosis of esophageal carcinoma, and to provide a new prognosis reference for esophageal carcinoma (EC).

METHODSSix hundred and seven patients received radical resection of thoracic esophageal carcinoma from May 2002 to June 2006 in our hospital, and their pre-operative CT images were transmitted to the three-dimensional conformal radiotherapy planning system by the network in digital format. Esophageal GTV targets were outlined and their GTV volumes were calculated. To analyze whether there is a relationship between GTV volume and pathologic lymph node metastasis or prognosis.

RESULTSIn the 607 cases of esophageal carcinoma, the GTV volume was (22.5 ± 16.8) cm(3) in 374 stage N0 EC patients, significantly different from that of (30.4 ± 20.1) cm(3) in 233 stage N1 EC cases (P < 0.001). There is a significant difference between the GTV volumes of the groups with and without lymph node metastasis (P < 0.05). There was a significant difference of the GTV volumes of EC patients with one lymph node metastasis and those with ≥ 4 lymph node metastasis (P < 0.05). There was a positive correlation between GTV volume and the number of lymph node metastasis (r = 0.230, P < 0.001). The 1-, 3-, 5-year survival rates since the surgery date were 83.8%, 53.5%, and 36.4%, respectively. There was a significant difference between the survival rates of stage N0 (48.5%) and stage N1 patients (18.2%, P < 0.001), and there was a significant difference between the survival rats of patients with 0, 1 and ≥ 2 lymph node metastasis (P < 0.01). Cox regression model analysis showed that GTV volume, number of lymph node metastasis, pathological type, and lesion site were independent prognostic factors (all P < 0.05).

CONCLUSIONThe GTV volume of esophageal carcinoma is positively correlated with the number of pathologic lymph node metastasis, and it is an independent prognostic factor for this cancer.

Adenocarcinoma ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Small Cell ; diagnostic imaging ; pathology ; surgery ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Radiotherapy, Conformal ; Survival Rate ; Tomography, X-Ray Computed ; Tumor Burden

OBJECTIVETo improve the accuracy of preoperative evaluation of cervical lymph node metastasis in thoracic esophageal squamous carcinoma.

METHODSForty-two patients with thoracic esophageal squamous carcinoma underwent neck ultrasonography. Enlarged lymph nodes with their long axis greater than 10 mm and a short-to-long axis ratio greater than 0.5 were considered as metastatic.

RESULTSPreoperative neck ultrasonography revealed the enlarged lymph nodes in 16 patients, but only in 5 (31%) cases the nodes were palpable. Among them 9 were classified as metastatic (cM(1-LN)), including 4 patients with palpable nodes. In 5 cM(1-LN) patients surgical intervention was canceled and the remaining 37 patients underwent trans-thoracic esophagectomy. Cervical node metastasis (pM(1-LN)) was confirmed pathologically in 6 surgical patients, 4 with tumors invading the adventitia (pT3) and the other 2 into the surrounding structure (pT(4)) (pT(1), pT(2) vs. pT(3), pT(4), P = 0.020). All 6 pM(1-LN) patients had concomitant mediastinal node metastasis and 4 of them had upper abdominal node metastasis. Statistically significant relationship was detected between cervical and abdominal nodal status (r = 0.536, P = 0.007). In comparison with the results of pathological examination and treatment response, the accuracy and sensitivity were 81% and 95% (P = 0.043), 36% and 82% (P = 0.081), respectively, for palpation and ultrasonography. Five out of 39 (13%) patients had their therapy changed due to ultrasonographic findings.

CONCLUSIONSNeck ultrasonography for cervical lymphadenopathy is of high sensitivity and accuracy, which plays an important role in the preoperative evaluation and therapeutic decision-making.

Adult ; Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; secondary ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Female ; Head and Neck Neoplasms ; diagnostic imaging ; secondary ; surgery ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; diagnostic imaging ; Lymphatic Metastasis ; diagnosis ; Male ; Middle Aged ; Neck ; diagnostic imaging ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND/AIMS: Unexpected diagnosis of synchronous second primary cancers (SPC) complicates physicians' decision-making because clinical details of squamous esophageal cancer (EC) patients with SPC have been limited. We evaluated clinical features and treatment outcomes of patients with synchronous SPC detected during the initial staging of squamous EC. METHODS: We identified a total of 317 consecutive patients diagnosed with squamous EC. Relevant clinical and cancer-specific information were reviewed retrospectively. RESULTS: EC patients with synchronous SPC were identified in 21 patients (6.6%). There were significant differences in median age (70 years vs. 63 years, p = 0.01), serum albumin level (3.3 g/dL vs. 3.9 g/dL, p < 0.01) and body mass index (20.4 kg/m2 vs. 22.8 kg/m2, p = 0.01) between EC patients with and without SPC. Head and neck, lung and gastric cancers accounted for 18.2%, 22.7%, and 18.2% of SPC, respectively. Positron emission tomography-computed tomography (PET-CT) detected four cases (18.2%) of SPC that were missed on CT. Management plans were altered in 13 of 21 patients (61.9%) with detected SPC. Curative esophagectomy was attempted in 28.6% of EC patients with SPC (vs. 59.1% of patients without SPC; p = 0.006). EC patients with SPC had significantly lower 5-year survival than patients without SPC (10.6% vs. 36.7%, p = 0.008). CONCLUSIONS: Synchronous SPC were found in 6.6% of squamous EC patients, and PET-CT contributed substantially to the detection of synchronous SPC. EC patients with SPC had poor survival due to challenges of providing stage-appropriate treatment.
Aged ; Carcinoma, Squamous Cell/diagnostic imaging/mortality/*pathology/therapy ; Esophageal Neoplasms/diagnostic imaging/mortality/*pathology/therapy ; Esophagectomy ; Esophagoscopy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary/diagnostic imaging/mortality/*pathology/therapy ; Positron Emission Tomography Computed Tomography ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome