Novel imaging strategies for upper gastrointestinal tract cancers

Abstract

Accurate pretherapeutic imaging is the cornerstone of all cancer treatment. Unfortunately, modern imaging modalities have several unsolved problems and limitations. The differentiation between inflammation and cancer infiltration, false positive and false negative findings as well as lack of confirming biopsies in suspected metastases may have serious negative consequences in cancer patients. This review describes some of these problems and challenges the use of conventional imaging by suggesting new combined strategies that include selective use of confirming biopsies and complementary methods to detect microscopic cancer dissemination.

Keywords:

• esophageal cancer
• gastric cancer
• GEJ cancer
• imaging
• pancreatic cancer
• review
• staging

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Accurate pretherapeutic imaging remains the key to both research and improved individual treatment strategies in patients with upper gastrointestinal (GI) cancer.

• Pretherapeutic evaluation based on a single imaging modality is insufficient for a complete and reliable evaluation, and clinically relevant findings (e.g., metastases suspected on positron emission tomography) may require cytological/histological confirmation in order to avoid false positive conclusions.

• At present, combined imaging strategies like computed tomography with endoscopic ultrasonography, laparoscopy and laparoscopic ultrasonography can reduce the number of futile laparotomies, and may provide a better stratification and thus selection of patients for neo-adjuvant trials.

• Future clinical trials in patients with upper GI cancer should rely on advanced combined imaging strategies with biopsies when clinically relevant.

• The combination of traditional imaging techniques, however, is not sufficient to identify patients with disseminated disease.

• Future strategies will include the use of high-resolution functional (molecular) evaluation methods in combination with fluid and blood analyses during diagnosis, staging and treatment response evaluation in patients with upper GI cancer.

Notes