title: Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessment.
abstract: OBJECTIVE
  To develop a CT-based prediction score for anastomotic leakage after esophagectomy and compare it to subjective CT interpretation.
  
  
  METHODS
  Consecutive patients who underwent a CT scan for a clinical suspicion of anastomotic leakage after esophagectomy with cervical anastomosis between 2003 and 2014 were analyzed. The CT scans were systematically re-evaluated by two radiologists for the presence of specific CT findings and presence of an anastomotic leak. Also, the original CT interpretations were acquired. These results were compared to patients with and without a clinical confirmed leak.
  
  
  RESULTS
  Out of 122 patients that underwent CT for a clinical suspicion of anastomotic leakage; 54 had a confirmed leak. In multivariable analysis, anastomotic leakage was associated with mediastinal fluid (OR = 3.4), esophagogastric wall discontinuity (OR = 4.9), mediastinal air (OR = 6.6), and a fistula (OR = 7.2). Based on these criteria, a prediction score was developed resulting in an area-under-the-curve (AUC) of 0.86, sensitivity of 80%, and specificity of 84%. The original interpretation and the systematic subjective CT assessment by two radiologists resulted in AUCs of 0.68 and 0.75 with sensitivities of 52% and 69%, and specificities of 84% and 82%, respectively.
  
  
  CONCLUSIONS
  This CT-based score may provide improved diagnostic performance for diagnosis of anastomotic leakage after esophagectomy.
  
  
  CONCLUSIONS
  • A CT-based score provides improved diagnostic performance for diagnosis of anastomotic leakage. • Leakage associations include mediastinal fluid, mediastinal air, wall discontinuity, and fistula. • A scoring system yields superior diagnostic accuracy compared to subjective CT assessment. • Radiologists may suggest presence of anastomotic leakage based on a prediction score.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, G.04.228, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands. L.Goense-2@umcutrecht.nl.|Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. L.Goense-2@umcutrecht.nl.
authors.forename: Lucas
authors.identifier: http://orcid.org/0000-0001-5824-8736
authors.initials: L
authors.lastname: Goense
authors.affiliation: Department of Surgery, University Medical Center Utrecht, G.04.228, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
authors.forename: Pauline M C
authors.initials: PMC
authors.lastname: Stassen
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Wessels
authors.affiliation: Department of Surgery, University Medical Center Utrecht, G.04.228, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.|Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter S N
authors.initials: PSN
authors.lastname: van Rossum
authors.affiliation: Department of Surgery, University Medical Center Utrecht, G.04.228, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maarten S
authors.initials: MS
authors.lastname: van Leeuwen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, G.04.228, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands. R.vanHillegersberg@umcutrecht.nl.
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging*; D019540:Area Under Curve; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Anastomotic leakage; Computed tomography; Esophageal cancer; Esophagectomy; Prediction score