[Value of x-ray computed tomography in cancer of the esophagus. Prospective and blind study]

Most complementary investigations assessing the resectability of esophageal carcinoma are not very accurate. In approximately half of the patients who undergo surgery, the surgeon discovers unknown growth extension of the tumor. The aim of this study was to define the place of CT scan in the assessment of esophageal cancer. A prospective study concerning 54 cases of squamous cell carcinoma was conducted during 18 months. We consecutively tested the sensitivity and the specificity of information supplied by a CGR 10000 CT scan. The reading was done by the same radiologist who was unaware of the other preoperative findings. All cases of carcinoma were proved histologically. The characteristics of the tumor itself were accurately described by CT scan. Tracheobronchial spread was correctly assessed in 96.2 p. 100 of cases; specificity was 100 p. 100. On the contrary, the sensitivity of the nodal involvement was weak (less than 55 p. 100) for the abdominal as well as the mediastinal areas. Moreover, CT scan identified 48 out of 49 patients without metastases. The results of this study did not allow to determine the value of signs of tumoral spread to the aorta, pericardium, and intra-abdominal regions and therefore CT scan can not be used to determine invasion of the pleural or peritoneal serosa. These results suggest that: a) CT scan alone is not sufficient in the assessment of patients for surgery, b) CT scan facilitates the choice of operative strategy, c) oncologic classification of non operative carcinoma, correct fields of radiation therapy, and follow-up of malignancy through chemotherapy are improved.