Tumor Staging of Advanced Esophageal Cancer: Combination of Double-Contrast Esophagography and Contrast-Enhanced CT
Yuichiro Yamabe1,
Yoshifumi Kuroki1,
Tsutomu Ishikawa2,
Kunihisa Miyakawa3,
Seiko Kuroki4 and
Ryuzo Sekiguchi1
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.
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Fig. 1A —78-year-old man with type 2 esophageal cancer located in
medial thoracic esophagus. Tumor was 105 mm; survival period was 2,694 days.
Transaxial contrast-enhanced CT scan through level of left mainstem bronchus
shows flattening of posterior wall. Diagnosis using CT alone was T4 based on
invasion of bronchus.
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Fig. 1B —78-year-old man with type 2 esophageal cancer located in
medial thoracic esophagus. Tumor was 105 mm; survival period was 2,694 days.
Frontal double-contrast esophagogram shows tumor and deepest ulcer are on
right posterior wall on opposite side of left main bronchus. These findings
led to diagnosis of T3 using CT and double-contrast esophagography.
Postoperative pathology revealed no invasion of left main bronchus.
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Fig. 2A —55-year-old man with type 2 esophageal cancer located in
upper thoracic esophagus. Tumor was 80 mm; survival period was 320 days.
Transaxial contrast-enhanced CT scan through level of primary bronchus shows
convex inward deformity of posterior wall. Diagnosis of T4 was made using CT
alone based on invasion of bronchus.
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Fig. 2B —55-year-old man with type 2 esophageal cancer located in
upper thoracic esophagus. Tumor was 80 mm; survival period was 320 days.
Frontal double-contrast esophagogram shows tumor and deepest ulcer are on left
posterior wall on opposite side of primary main bronchus, leading to diagnosis
of T3 using CT and double-contrast esophagography. Postoperative pathology
revealed no invasion of primary main bronchus.
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Fig. 3 —Survival curve of pT3 and pT4 cases. For patients with pT3
disease, 3-year survival rate was 44% and median survival time was 792 days.
For patients with pT4 disease, 3-year survival rate was 19% and median
survival time was 256 days. Significant difference was observed between two
stages (p = 0.001).
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Fig. 4 —Survival curve of T3 and T4 cases diagnosed using CT alone.
For patients with T3 disease, 3-year survival rate was 42% and median survival
time was 644 days. For patients with T4 disease, 3-year survival rate was 26%
and median survival time was 367 days. No significant difference was observed
between two stages (p = 0.055).
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Fig. 5 —Survival curve of T3 and T4 cases diagnosed using both CT and
double-contrast esophagography. For patients with T3 disease, 3-year survival
rate was 42% and median survival time was 783 days. For patients with T4
disease, 3-year survival rate was 21% and median survival time was 263 days.
Significant difference was observed (p = 0.024).
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Copyright © 2008 by the American Roentgen Ray Society.
