Adenocarcinoma of the gastroesophageal junction: barium and CT examination

Seventy-seven patients with adenocarcinoma of the gastroesophageal junction were evaluated with upper gastrointestinal barium studies (single-contrast, 40: double-contrast, 37) and 21 of these had preoperative computed tomography for staging. Single- and double-contrast studies were equally sensitive in detecting exophytic tumors, but double-contrast studies were slightly more sensitive (25 of 26) than single-contrast examinations (21 of 25) in detecting infiltrating tumors. Computed tomography accurately staged 18 (86%) of 21 cases (16 unresectable, two resectable). The most reliable computed tomographic findings of tumor unresectability were metastases (liver, adrenal) and local tumor extension, both found in 10 (48%) of 21 cases, and regional adenopathy, present in eight (38%) of 21 cases. The presence or absence of the periesophageal soft-tissue planes was an unreliable finding and led to both false-positive (two cases) and false-negative (four cases) diagnoses. CT-guided percutaneous fine-needle aspiration biopsy was used successfully in four cases to obtain a cytologic diagnosis of metastatic adenocarcinoma.