Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT.
OBJECTIVE
The objective of this study was to compare the diagnostic accuracy of tumor staging in patients with advanced esophageal cancer based on contrast-enhanced CT findings alone with that based on a combination of CT and double-contrast esophagography and to evaluate the relevance of tumor stage to survival rate.


METHODS
In 94 patients who underwent surgery as the primary treatment for esophageal cancer and had a diagnosis of postoperative T stage 3 (pT3) or pT4 disease based on pathologic examination, T stage was evaluated using CT alone and using a combination of CT and double-contrast esophagography. The diagnostic criterion for T4 disease using CT alone was tumor strongly displacing or deforming adjacent organs. The diagnostic criterion for T4 disease using the combined method was tumor displacing or deforming adjacent organs in the direction that corresponded to the direction of the location of the tumor or the deepest ulcer as diagnosed by barium esophagography. Concordance of T staging based on imaging with postoperative T staging based on pathology results, the gold standard, and survival rate were assessed for CT alone and for the combined method.


RESULTS
The concordance rate with postoperative T staging pathology results was 78% for CT alone and 84% for CT and double-contrast esophagography combined, with a significant difference between the two diagnostic methods. For patients with a diagnosis of T3 and those with a diagnosis of T4 using CT alone, the 3-year survival rate was 42% and 26%, respectively, with no significant difference between the two. For patients with a diagnosis of T3 and those with a diagnosis of T4 using the combined method, the 3-year survival rate was 42% and 21%, respectively, with a significant difference between the two.


CONCLUSIONS
The diagnostic performance of contrast-enhanced CT and double-contrast esophagography combined in staging advanced esophageal tumors is better than that of CT alone and thus has potential for estimating prognosis.
Yamabe
Yuichiro
Y
Department of Diagnostic Imaging, Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya-shi, Tochigi 3200834, Japan. y-yamabe@jb3.so-net.ne.jp
Kuroki
Yoshifumi
Y
Ishikawa
Tsutomu
T
Miyakawa
Kunihisa
K
Kuroki
Seiko
S
Sekiguchi
Ryuzo
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007455:Iodine; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D001466:Barium Sulfate; D007455:Iodine