Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus.
OBJECTIVE
The purpose of our investigation was to determine the usefulness of barium studies for differentiating benign and malignant strictures of the esophagus.


METHODS
A search of radiology and endoscopy files revealed 100 patients with esophageal strictures on barium studies who underwent endoscopy (with endoscopic brushings or biopsy specimens in 57). The images from these barium studies were reviewed by two gastrointestinal radiologists who were unaware of the clinical, endoscopic, and pathologic findings; these observers classified the strictures as having a benign, malignant, or equivocal appearance. The radiographic data were correlated with the endoscopic and pathologic findings to determine the usefulness of barium studies for differentiating benign strictures from malignant tumor.


RESULTS
Of the 100 esophageal strictures detected on barium studies, 75 (75%) had a benign radiographic appearance, 11 (11%) had a malignant appearance, and 14 (14%) had an equivocal appearance. None of the 75 patients with radiographically benign strictures had malignant tumor on endoscopy, which revealed benign strictures in 48 patients and no definite strictures in the remaining 27. Conversely, all 11 patients (100%) with radiographically malignant strictures had malignant tumor on endoscopy. Finally, 13 (93%) of 14 patients with radiographically equivocal strictures had benign strictures without tumor on endoscopy and one (7%) had esophageal carcinoma.


CONCLUSIONS
Radiographically benign esophageal strictures are not found to be caused by malignant tumor on endoscopy, so these patients can be treated medically before endoscopy or endoscopic dilatation procedures are performed. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.
Gupta
Sonya
S
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
Levine
Marc S
MS
Rubesin
Stephen E
SE
Katzka
David A
DA
Laufer
Igor
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003287:Contrast Media; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D004940:Esophageal Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography
D003287:Contrast Media; D001466:Barium Sulfate