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Ann Thorac Surg 1985;40:561-565
© 1985 The Society of Thoracic Surgeons

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Articles

Evaluation of Noninvasive Tests for the Preoperative Staging of Carcinoma of the Esophagus: A Prospective Study

From the Surgery Branch, National Cancer Institute, and the Diagnostic Radiology Section, Clinical Center, National Institutes of Health, Bethesda, MD

Accepted for publication January 26, 1985.

^* Address reprint requests to Dr. Roth. Thoracic Oncology Section, Surgery Branch, National Cancer Institute, Building 10, Room 2B07, Bethesda, MD 20205

A prospective study was undertaken to define the usefulness of conventional full-lung linear tomography, radionuclide liver plus spleen and bone scans, and thoracic and abdominal computed tomography for the preoperative staging of carcinoma of the esophagus. Thirty-three patients with carcinoma of the esophagus were studied. The computed tomographic (CT) scan of the thorax and upper abdomen was the single most accurate noninvasive study. With computed tomography, the relationship of the tumor to the tracheobronchial tree was the feature most useful in predicting local resectability. In all patients with the finding of tracheobronchial compression by the tumor, the tumor could not be resected completely. The predictive value of this CT finding in patients with locally unresectable tumor was high (0.83), indicating its usefulness in assessing unresectability. The CT finding of visible separation between tumor mass and tracheobronchial tree was present in 10 of 14 patients with locally resectable tumor (predictive value, 0.63). However, tumor abutting the tracheobronchial tree without compression was a poor predictor of unresectability (predictive value, 0.36). The radionuclide bone scan was the only other noninvasive study to demonstrate a metastasis not evident by CT scan. The combination of chest and abdominal CT scan, bone scan, and bronchoscopy before operation will accurately stage the majority of patients with esophageal cancer but no noninvasive test is of sufficient reliability to exclude patients from operative resection if otherwise indicated.

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