Sensitivity and Specificity of Chest CT for Detection of Esophageal Cancer

Esophageal cancer (EC) has poor survival due to frequent late-stage diagnosis. Endoscopy is the diagnostic gold standard but is invasive and limited in evaluating extraluminal disease. Chest CT, commonly performed for various indications, visualizes the esophagus and surrounding structures and may allow earlier or incidental EC detection. This study assesses the diagnostic performance of chest CT compared with endoscopy.

In this IRB-approved retrospective study, 85 adults with pathologically confirmed esophageal adenocarcinoma or squamous cell carcinoma were matched to 85 controls with normal chest CTs. Pretreatment CTs, with or without contrast, were independently reviewed by three thoracic radiologists blinded to clinical and pathologic data. Readers evaluated esophageal morphology, suspicion for malignancy, lymphadenopathy, metastatic disease, and related findings using a standardized scoring system. Diagnostic performance was compared with endoscopy. Inter-reader agreement was assessed with Fleiss' kappa, and logistic regression identified factors associated with EC.

Abnormal esophageal morphology on consensus CT interpretation yielded 74.1% accuracy, 77.6% sensitivity, and 70.6% specificity. Suspicion for malignancy increased accuracy to 78.2% with high specificity (92.9%) but lower sensitivity (63.5%). Contrast-enhanced CT performed similarly. Inter-reader agreement ranged from fair to substantial. False negatives were common, often in the presence of hiatal hernia. Younger age, smoking history, suspicion for malignancy, and hiatal hernia were independently associated with EC.

Chest CT shows moderate diagnostic performance and high specificity for EC but insufficient sensitivity to replace endoscopy. It may support incidental detection and prompt earlier evaluation when abnormal morphology and risk factors are present.