• Ben M Eyck, Barbera D Onstenk, Bo J Noordman, Daan Nieboer, Spaander Manon C W MCW Department of Gastroenterology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands., Roelf Valkema, Sjoerd M Lagarde, Wijnhoven Bas P L BPL Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands., and van Lanschot J Jan B JJB Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands..
• Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
• Ann. Surg. 2020 Feb 1; 271 (2): 245-256.

ObjectiveThe aim of this study was to perform a meta-analysis on the accuracy of endoscopic biopsies, EUS, and 18F-FDG PET(-CT) for detecting residual disease after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer.Summary Of Background DataAfter nCRT, one-third of patients have a pathologically complete response in the resection specimen. Before an active surveillance strategy could be offered to these patients, clinically complete responders should be accurately identified.MethodsEmbase, Medline, Cochrane, and Web-of-Science were searched until February 2018 for studies on accuracy of endoscopic biopsies, EUS, or PET(-CT) for detecting locoregional residual disease after nCRT for squamous cell- or adenocarcinoma. Pooled sensitivities and specificities were calculated using random-effect meta-analyses.ResultsForty-four studies were included for meta-analyses. For detecting residual disease at the primary tumor site, 12 studies evaluated endoscopic biopsies, 11 qualitative EUS, 14 qualitative PET, 8 quantitative PET using maximum standardized uptake value (SUVmax), and 7 quantitative PET using percentage reduction of SUVmax (%ΔSUVmax). Pooled sensitivities and specificities were 33% and 95% for endoscopic biopsies, 96% and 8% for qualitative EUS, 74% and 52% for qualitative PET, 69% and 72% for PET-SUVmax, and 73% and 63% for PET-%ΔSUVmax. For detecting residual nodal disease, 11 studies evaluated qualitative EUS with a pooled sensitivity and specificity of 68% and 57%, respectively. In subgroup analyses, sensitivity of PET-%ΔSUVmax and EUS for nodal disease was higher in squamous cell carcinoma than adenocarcinoma.ConclusionsCurrent literature suggests insufficient accuracy of endoscopic biopsies, EUS, and 18F-FDG PET(-CT) as single modalities for detecting residual disease after nCRT for esophageal cancer.

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