Role of computed tomographic scans in the staging of esophageal and proximal gastric malignancies

• Published in: The American journal of surgery Vol. 165; no. 5; pp. 558 - 560
• Main Authors: Maerz, Linda L., Deveney, Clifford W., Lopez, Richard R., McConnell, Donald B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.1993; Elsevier Limited
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - secondary; Computed tomography; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophagus; Gastric cancer; Humans; Liver; Liver Neoplasms - secondary; Lymphatic Metastasis; Malignancy; Medical imaging; Metastases; Metastasis; Middle Aged; Neoplasm Staging; Parameter sensitivity; Predictive Value of Tests; Scanning; Sensitivity and Specificity; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Tomography, X-Ray Computed
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(05)80434-9

In order to determine the accuracy of computed tomographic (CT) scanning, CT scan results were compared with operative and pathologic findings in 45 patients with esophageal and proximal gastric malignancies. CT scans were evaluated with respect to nodal metastases, hepatic metastases, and adjacent spread. Eight patients did not undergo surgery because of advanced disease noted on the CT scan. Of the remaining 37 patients, sensitivity of CT for all 3 parameters was less than 60%, whereas the specificity was greater than 90%. The positive predictive value was greater than 90% for nodal metastases and adjacent spread and 67% for hepatic metastases. The negative predictive value was less than 40% for nodal metastases and adjacent spread and 90% for hepatic metastases. For esophageal and proximal gastric malignancies, CT is useful in identifying advanced disease and in predicting resectability. In less advanced cases, CT is not sensitive, and its negative predictive value is poor with regard to local and lymphatic spread. CT scanning is useful to stage the most advanced cases but because of limited accuracy should be combined with other diagnostic studies when accurate staging is required.