Computed tomography for staging of oesophageal cancer

Computed tomography (CT) is still widely used in the staging of patients with carcinoma of the oesophagus. The aim of the study was to evaluate the diagnostic accuracy of CT in a series of patients with carcinoma of the oesophagus or the cardia. Results were compared with findings at surgery or autopsy.

47 consecutive patients of whom 30 underwent operation while 17 patients were not candidates for surgery due to advanced disease.

Demonstration of tumour invasion on CT in 30 patients who underwent operation had an accuracy of 63%, a nosographic sensitivity of 10% and a specificity of 90%. Diagnosis of metastases to abdominal lymph nodes had an accuracy of 57%, and a nosographic sensitivity and specificity of respectively 37% and 90%. The assessment of tumour invasion and metastases to lymph nodes in patients not candidates for surgery was expectedly more accurate (100 and 67%, respectively, in nine autopsies).

CT may provide valuable information in pretherapeutic staging of oesophageal cancer by identifying patients with advanced disease, who are not candidates for surgery. In patients without signs of dissemination on CT additional information may be obtained from endoscopic ultrasonography and laparoscopy.