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Tumor Staging of Advanced Esophageal Cancer: Combination of Double-Contrast Esophagography and Contrast-Enhanced CT

¹ Department of Diagnostic Imaging, Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya-shi, Tochigi 3200834, Japan.
² Department of Radiology, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi, Japan.
³ Nagano PET Imaging and Diagnostic Center, Magano-shi, Japan.
⁴ National Cancer Center, Research Center for Cancer Prevention and Screening, Cancer Screening Division, Tokyo, Japan.

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.

MATERIALS AND 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.

CONCLUSION. 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.

Keywords: CT • double-contrast esophagography • esophageal cancer • esophagography • survival curve • T stage

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