bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.073: THE APPLICATION OF ARTIFICIAL INTELLIGENCE IN ESOPHAGEAL CANCER SCREENING AND PREDICTION OF LYMPH NODE METASTASIS
Authors: Yu Zhang 
Published: September 2018

Abstract

Background
Artificial intelligence become the latest hot spot in medical applications, especially in diagnostics and radiology and pathology in do a preliminary exploration, prediction of esophageal cancer screening and early esophageal cancer staging has a revolutionary significance.

Methods
Several large esophageal cancer treatment center of esophageal pathology as a result, the imaging results (including CT, PET, CT, ultrasound, EUS, etc.), gastroscopy, follow-up medical records and other data import to the artificial intelligence software, through artificial intelligence under the big data automatically after the learning process, susceptible to test results and the clinic has confirmed into the software, after analysis results with the postoperative pathology, endoscopy results, PET—CT results such as comparison, analysis of accuracy and sensitivity.

Results
Through automatic learning of artificial intelligence, early cancer screening was performed for susceptible people, and the patients who had been diagnosed had esophageal cancer staging and lymph node metastasis. Artificial intelligence will continuously improve the accuracy and sensitivity of the diagnosis in the learning process, and it is revolutionary.

Conclusion
In the past, the early cancer screening and staging of esophageal cancer was found, and the search for lymph node metastasis was not based on a large number of data, high sensitivity and small trauma. Through artificial intelligence, we can solve many diagnostics problems and establish a large database of esophageal cancer, which will bring great significance to the diagnosis and research of esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.075: USEFULNESS OF FDG-PET TO DECIDE THE INDICATION FOR ENDOSCOPIC RESECTION FOR SUPERFICIAL ESOPHAGEAL CANCER
Authors: Nakajima Masanobu , Muroi Hiroto , Kikuchi Maiko , Tani Yukiko , Yamaguchi Satoru , Sasaki Kinro 
Published: September 2018

Abstract

Background
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful imaging modality to reflect the tumor activity. However, FDG-PET is mainly used for advanced cancer rather than superficial cancer. In this study, we investigate the relationship between the superficial tumor depth of esophageal cancer and FDG uptake, and discuss the possibility of using FDG-PET in making the decision for performing endoscopic resection.

Methods
From 2009 to 2017, 444 esophageal cancer patients underwent esophagectomy or Endoscopic submucosal dissection (ESD), and 195 were diagnosed with pathological superficial cancer. Among them, 146 patients were examined by FDG-PET before esophagectomy or ESD. For these 146 patients, the relationship between pathological tumor depth and FDG uptake was analyzed.

Results
Mean maximun standardized uptake value (SUV Max) in pT1a-EP/LPM was 1.362 ± 0.890, pT1a-MM/pT1b-SM1 was 2.453 ± 1.872, and pT1b-SM2/SM3 was 4.265 ± 3.233 (P < 0.0001). Among 51 pT1a-EP/LPM tumors, 10 (19.6%) showed positive detection of FDG. For pT1a-MM/pT1b-SM1 and pT1b-SM2/SM3, the detection rates were 52.9% (18/34) and 82.0% (50/61), respectively. The detection rate for pT1a-EP/LPM was significantly lower than for the other two groups (P < 0.0001). Among 10 FDG-PET positive patients, the reason for one lesionbeing PET positive could not be determined; however, nine of ten lesions had suitable reasons for the lesions being detected by PET and thus not being ER indication. PET diagnosis tends to be more accurate than endoscopic diagnosis (P = 0.0574)

Conclusion
Negative detection of superficial esophageal sqamous cell carcinoma by FGD-PET is useful for deciding the indication for ER. Furthermore, when FDG uptake is recognized, a therapeutic modality other than ER should be considered.

Disclosure
All authors have declared no conflicts of interest.
PS02.076: VISUALIZATION OF BLOOD SUPPLY ROUTE TO THE RECONSTRUCTED STOMACH BY INDOCYANINE GREEN FLUORESCENCE IMAGING DURING ESOPHAGECTOMY, 2ND REPORT
Authors: Rino Yasushi , Oshima Takashi , Sato Tsutomu , Aoyama Toru , Yukawa Norio , Yamada Takanobu , Hayashi Tsutomu , Ogata Takashi , Yoshikawa Takaki , Masuda Munetaka 
Published: September 2018

Abstract

Background
Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We have reported the three blood supply routes to the reconstructed stomach using ICG fluorescence imaging for reconstruction during esophagectomy. Blood flow routes in the 33 patients with esophageal cancer were classified into categories on the basis of ICG imaging findings: the gastric wall route, the greater curvature route, and the omentum and splenic hiatal route. The gastric wall route was found in 13 patients and characterized by large blood vessels in the gastric wall. The greater curvature route was present in 11 patients and characterized by blood vessels in the greater omentum. The omentum and beside splenic hilum route was found in 22 patients. Blood vessels ran in the greater omentum beside the splenic hilum. a photodynamic eye (PDE) showed blood flow from right gastroepiploic artery, omentum vessels, left gastroepiploic artery, splenic hiatal vessels, short gastric artery, and gastric wall vessels to the top of the reconstructed stomach. The ‘splenic hiatal route’ was present in 66.7% of the patients and was formed by large vessels or networks of small vessels. We rechecked the ‘splenic hiatal route’ cases and recognize that the branch parted from the right gastroepiploic artery. We tried preservation of the ‘splenic hiatal route’.

Methods
Since January 2017, we have preserved the ‘splenic hiatal route’ and performed ICG fluorescence imaging in 5 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.

Results
ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was visualized the ‘splenic hiatal route’ in all patients.

Conclusion
On ICG fluorescence imaging, the splenic hiatal vessels would be the major blood supply for the anastomosis in most patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.079: ESOPHAGEAL ADENOCARCINOMA: CT, PET, EUS SENSITIVITY/SPECIFICITY FOR THE PREOPERATIVE ASSESSMENT OF LYMPH NODE METASTASES IN SINGLE THORACIC AND ABDOMINAL NODAL STATIONS
Authors: Kauppi Juha , Lugaresi Marialuisa , Lopci Egesta , Daddi Niccolò , Räsänen Jari , Mattioli Sandro 
Published: September 2018

Abstract

Background
In esophageal adenocarcinoma clinical staging (cStaging), interest for N-descriptor according to single lymph nodal station has emerged, but no specific data are available. CT, PET, EUS sensitivity/specificity for N-descriptor in single stations were investigated.

Methods
In 101 esophageal adenocarcinoma cases (60/41 Siewert I/II) preoperative staging and primary radical surgical resection (prospective protocols) were performed. Resected lymphatic nodes (LNY) and lymphatic metastases (LNM) were reported for the following stations: A) right paratracheal/sub carinal/pulmonary ligament; B) paraesophageal thoracic; C) pericardial; D) left gastric artery, lesser curvature; E) celiac trunk, hepatic/splenic artery. Pathological N data were compared with clinical N-descriptors.

Results
LN stations: A) LNY 137 LNM 6, Sensitivity CT 58.3%, PET 7.1%, EUS 87.5%—Specificity CT 94.3%, PET 98.8%, EUS 88.6%; B) LNY 79 LNM 18, Sensitivity CT 33.3%, PET 20%, EUS 80%—Specificity CT 92.1%, PET 96.6%, EUS 87.2%; C) LNY189 LNM 36, Sensitivity CT 46.6%, PET 23.5%, EUS 28.5%—Specificity CT 95.3%, PET 97.5%, EUS 97.7%; D) LNY 383 LNM 66, Sensitivity CT 24.1%, PET 21.4%, EUS 33.3%—Specificity CT 97.2%, PET 97.2%, EUS 100%; E) LNY 148 LNM 17, Sensitivity CT 13.3%, PET 5.5%, EUS 33.3%—Specificity CT 93%, PET 98.7%, EUS 95.2%. Figure Staging in adenocarcinoma of the esophageal-gastric junction; CT (A), PET (B) and fused PET/CT sessions (C) at the level of the primary tumor (red arrows) and para-esophageal lymph nodes including one PET-positive (red arrowheads), and one PET-negative detectable on CT only (yellow arrowheads). Panel D the box-plot for median SUVmax according to pathologic lymph node status. In the true positive lymph nodes, SUVmax was significantly higher than in true negative (median, 13.6 vs 5.0, P = 0.001) and false negative lymph nodes (median, 13.6 vs 6.9; P = 0.026). Abbreviations: FN = false negative; TP = true positive; TN = true negative.

Conclusion
For esophageal adenocarcinoma cStaging, CT, PET, EUS N-descriptor is not reliable, particularly PET data for N stations close to primary T. To tailor therapy, new biological descriptors are necessary.

Disclosure
All authors have declared no conflicts of interest.
PS02.081: ADVANCED PRETREATMENT STAGE IN OESOPHAGEAL CANCER NOT ASSOCIATED WITH POOR OUTCOMES
Authors: Newton Nick , Phillips Alex , Jaretzke Helen , Immanuel Arul , Hayes Nick , Michael Griffin S 
Published: September 2018

Abstract

Background
Following a diagnosis of oesophageal cancer UICC TNM staging guides treatment and informs prognosis. There is recognised variance between clinical staging (cTNM) and post-operative pathological staging (pTNM). T3N3 oesophageal cancers have a 5-year survival of less than 25% in most studies; given the morbidity associated with radical treatment these cancers may not be considered curable.

Methods
A database of patients treated in a high volume UK tertiary referral centre was interrogated for all cT3N3M0 patients. Demographics, pathological stage and outcomes were recorded.

Results
From 2011 to 2016 34 patients met the inclusion criteria of cT3N3M0 oesophageal cancer. 11 patients had squamous cell carcinoma, the remainder adenocarcinoma. Median age was 65. Predicted overall survival at two years was 71% with a median overall survival of 54 months. 29 patients had neoadjuvant chemotherapy. All patients had an R0 resection. In 15% of patients clinical stage equated to pathological stage, 9% were ’understaged’, 76% had a better prognostic pathological stage.

Conclusion
Staging is considered important to allow treatment to be tailored to the individual patient. Identifying an unfavourable clinical stage may prevent inappropriate treatment, but may disadvantage patients who are erroneously ‘overstaged’. This study highlights variance between pre-treatment clinical staging and post-operative pathological staging. Care should be taken when making treatment decisions and counselling patients who have a poor prognostic clinical stage.

Disclosure
All authors have declared no conflicts of interest.
PS02.083: CIRCULATING CELL FREE TUMOR DNA FOR DISEASE MONITORING AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: PROOF-OF-PRINCIPLE
Authors: Eyck B , Noordman B , Van Der Wilk Berend , Jansen M , Atmodimedjo P , Martens J , Lagarde Sjoerd M , Wijnhoven Bas P L , Van Lanschot J J B , Dinjens W 
Published: September 2018

Abstract

Background
An active surveillance approach has been proposed for patients with a clinically complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer (SANO trial). To justify renouncing surgical resection, patients with residual disease after nCRT should be accurately identified. However, substantial residual disease (TRG3–4) cannot be detected in 10% of patients with current diagnostic tests (preSANO trial). Circulating cell free tumor DNA (ctDNA) potentially improves detection of residual malignancy after nCRT and could be used for disease monitoring. The objective of this study was to investigate the feasibility of using ctDNA as biomarker for disease status after nCRT in esophageal cancer.

Methods
Twelve typical patients from the preSANO trial with variable pathological responses to nCRT were included. Blood was drawn and processed pretreatment. The feasibility of detecting TP53 mutations in baseline tumor biopsies was investigated using a next generation sequencing (NGS) panel. Subsequently, baseline blood samples of patients in whom specific TP53 mutations could be identified in baseline tumor biopsies or the surgical resection specimen were analyzed for ctDNA using cell free DNA NGS kits with single molecule barcoding (Oncomine Thermo Fisher).

Results
Baseline biopsy samples were available in 8 out of 12 patients. In 7 of these 8 patients (88%) specific TP53 mutations could be identified in their baseline biopsies. In 11 out of 12 patients (92%) specific TP53 mutations could be identified in baseline biopsies or the resection specimen. Eight of these 11 mutations were potentially detectable by the Oncomine panel. The panel detected TP53 mutational ctDNA in 4 of these 8 samples (50%).

Conclusion
Specific and clonal TP53 mutations can be identified in pretreatment biopsy samples and in surgical resection specimens of patients with esophageal cancer. These mutations can be matched to ctDNA identified in blood samples. Hence, ctDNA analyses in blood samples can potentially be used for disease monitoring during active surveillance and for disease monitoring in follow-up after surgical resection.

Disclosure
All authors have declared no conflicts of interest.
PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Groen Jasper , Gisbertz Suzanne , Van Berge Henegouwen Mark I , Slaman Annelijn E , Meijer Sybren , Hulshof Maarten , Lagarde Sjoerd M , Bergman Jacques , Van Laarhoven Hanneke , Bennink Roel J 
Published: September 2018

Abstract

Background
Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy.

Methods
All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated.

Results
A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%.

Conclusion
The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group.

Disclosure
All authors have declared no conflicts of interest.
PS02.087: EARLY RESPONSE EVALUATION OF NEOADJUVANT THERAPY WITH PET/MRI TO PREDICT RESECTABILITY IN PATIENTS WITH ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION
Authors: Achiam Michael , Löfgren Johan , Belmouhand Mohamed , Hjorth Johannesen Helle , Baeksgaard Lene 
Published: September 2018

Abstract

Background
The primary treatment for locally advanced adenocarcinoma of the esophagogastric junction remains surgery combined with neoadjuvant chemo- or chemoradiotherapy (NT). A prediction of response to NT would be valuable, as insufficient response following NT may reflect therapy resistance leading to disease progression, unnecessary delay of surgery and risk of unresectability. Determining insufficient response to NT could lead to change of therapy and reduce possible chemo(radio)therapy toxicity. Positron Emission Tomography (PET)/Magnetic Resonance Imaging (MRI) is a new modality that has showed promising results for various clinical indications. Currently, evaluation of neoadjuvant therapy (NT) among patients with adenocarcinoma of the esophagogastric junction has primary been reserved for PET/computed tomography (CT). The aim of this study was to investigate if simultaneous PET/MRI is a feasible method to evaluate early tumor response to predict resectability in patients with AEG during NT. We also examined the association between histopathological response and changes on PET/MRI during NT.

Methods
Patients with untreated adenocarcinoma of the esophagogastric junction (Siewert's I/II) and fit for NT with no contraindications for PET/MRI were considered eligible. A baseline scan was performed prior to NT induction and an evaluation scan 3 weeks later. For histopathological response evaluation the Mandard tumor regression grade score was applied. Response on PET/MRI was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and change in ADC and SUVmax values.

Results
Twenty-eight patients were enrolled, and 22 completed both scans and proceeded to our final analyses. 17 patients were found resectable vs. five not resectable. PET/MRI response evaluation is a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction with sensitivity 94%, specificity 80%, and AUC = 0.95. However, no association with histopathological response (tumor regression grade) was found nor was RECIST correlated with resectability.

Conclusion
Our work has identified response evaluation with PET/MRI as a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction, however, larger studies are warranted to justify the use of this modality for this indication.

Disclosure
All authors have declared no conflicts of interest.
PS02.089: METABOLIC RESPONSE FOR CHEMORADIOTHERAPY PREDICTS PROGNOSIS OF PATIENTS TREATED WITH NEOADJUVANT THERAPY PLUS ESOPHAGECTOMY FOR ADVANCED ESOPHAGEAL CANCER
Authors: Motoyama Satoru , Sato Yusuke , Wakita Akiyuki , Kawakita Yuta , Nagaki Yushi , Minamiya Yoshihiro 
Published: September 2018

Abstract

Background
We evaluated that metabolic response using [18F]-Fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT) predicts survival outcome in patients treated with neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy for thoracic esophageal squamous cell carcinoma (TESCC).

Methods
Fifty consecutive Japanese patients with cStage IIB-IV TESCC, treated at our hospital between April 2009 and January 2014, were enrolled. We analyzed the metabolic response (fractional decrease in tumor maximum standardized uptake value) to NACRT. Independent prognostic factors predictive of 3-year survival were investigated using univariate and multivariate analysis.

Results
The study participants included 41 (82%) males and 9 (18%) females, with an age of 62.5 (rage 43–74) years. All 42 patients examined were found to be positive for tumors on FDG-PET/CT before treatment. After NACRT, 28% (10/36) of patients had changed from positive to negative for tumor on FDG-PET/CT. Seventy-one percent (30/42) of patients were positive for lymph node involvement on FDG-PET/CT before treatment. After NACRT, 81% (22/27) of patients previously positive for lymph node involvement were negative on FDG-PET/CT. The median fractional decrease in tumor SUVmax was 75% (range = 19–90%). We found that there was a significant correlation between a decrease in FDG-PET/CT and recurrence. Consistent with those findings, univariate and multivariate analysis taking into consideration age, gender, cT, cN, cM, adverse events, interval between NACRT and surgery, number of dissected LNs, pT, pN, pCR, pathological response, and fractional decrease in tumor SUVmax showed that fractional decrease in tumor SUVmax of < 75% to be significant prognostic factors associated with poorer survival.

Conclusion
Metabolic response as a decrease in SUVmax of ≥ 75% was an independent prognostic factor for 3-year overall survival in multivariate analysis and associated with recurrence. On the other hand, cT, cN, pT, pN, pCR were not associated with survival outcome or recurrence.

Disclosure
All authors have declared no conflicts of interest.
PS02.093: LYMPH NODE METASTASES IN T1 OESOPHAGEAL ADENOCARCINOMA: WHAT IS THE REAL RISK IN EARLY OESOPHAGEAL CANCER?
Authors: Mitchell David , Falk Gregory , Yeluri Sashi 
Published: September 2018

Abstract

Background
Lymph node status is regarded as the most important factor for prognosis for oesophageal cancer. T1 oesophageal adenocarcinoma management has shifted from oesophagectomy only to include endoscopic management as part of the algorithm, with some bodies (National Comprehensive Cancer Network (NCCN) 2016) recommending it for management of T1a disease and selected T1b disease. We reviewed the literature to assess the true risk of lymph node metastasis in patients with T1 oesophageal adenocarcinoma.

Methods
Medline, Embase, Pubmed and Cochrane where searched for manuscripts in english reviewing the lymph node metastasis in superficial (T1) oesophageal adenocarcinoma. The main outcome was reviewing the risk of lymph node metastasis in T1a and T1b oesophageal adenocarcinoma. Secondary outcomes looked at the rate of lymph node metastasis for T1b cancers based on degree of submucosal involvement (SM1, SM2 and SM3). Studies were excluded if neo-adjuvant chemotherapy or radiotherapy were received and if the surgical lymph node yield was < 15 lymph nodes.

Results
38 Studies were identified. 22 studies were excluded due to low lymph node yield (< 15) or insufficient statistical analysis. For the 16 studies, a total of 1422 cases were included. 533 patients had T1a adenocarcinoma with 11 patients demonstrating positive lymph nodes (2%). 849 had T1b adenocarcinoma with 189 patients demonstrating positive lymph nodes (22%). Eight Studies did subgroup analysis of T1b lesions with a total of 365 patients identified. The rate of lymph node positivity for SM1, SM2 and SM3 was 17.9%, 16.6% and 29.6% respectively.

Conclusion
Early oesophageal adenocarcinoma (T1) is increasing in prevalence due to surveillance of pre-malignant conditions (Barrett's Oesophagus).
Recently some bodies recommend the use of endoscopic mucosal resection as first line therapy for T1a disease. It is important to inform our patients the risk of lymph node metastasis is low but significant (2%). Given in specialised units, oesophagectomy can be performed with low mortality (< 1%) and morbidity with good quality of life it is justifiable to recommend oesophagectomy or endoscopic management in patients who are fit enough for surgery. For T1b disease an oesophagectomy is the gold standard of treatment given the significant risk of lymph node positivity (22%).

Disclosure
All authors have declared no conflicts of interest.