Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer

• Published in: Clinical radiology 2004-06, Vol.59 (6), p.499-504
• Main Authors: Weaver, S.R, Blackshaw, G.R.J.C, Lewis, W.G, Edwards, P, Roberts, S.A, Thomas, G.V, Allison, M.C
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adult; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - ultrastructure; Computed tomography; Endoluminal ultrasound; Endosonography - methods; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neoplasm Staging - methods; Neoplasm Staging - standards; Oesophageal cancer surgery; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sensitivity and Specificity; Tomography, X-Ray Computed - methods
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2003.11.016

AIMS: To assess the strength of agreement between the perceived pre-operative stage of oesophageal tumours as determined by spiral computed tomography (CT) and endoscopic ultrasound (EUS), both alone and in combination, with the histopathological stage. METHODS: Sixty patients with oesophageal cancer underwent both pre-operative CT and EUS performed by two consultant radiologists with a special interest in upper gastrointestinal radiology. The strength of the agreement between the radiological stage and the histopathological stage was determined by means of the weighted Kappa statistic (Kw). RESULTS: Sensitivity for T and N stages was 58% and 79% for CT, and 72% and 91% for EUS. Specificity for T and N stages was 80% and 84% for CT, and 85% and 68% for EUS. Kw for T and N stages was 0.455 ( p=0.0001) and 0.603 ( p=0.0001) for CT compared with 0.604 ( p=0.0001) and 0.610 ( p=0.0001) for EUS. In patients when CT and EUS agreed regarding the T and N stages, the strength of agreement between the radiological and the histopathological stage was greater (Kw T 0.613 ( p=0.0001), Kw N 0.781 ( p=0.0001)). CONCLUSION: CT and EUS are complimentary techniques for the staging of oesophageal tumours, and these results reinforce the importance of specialist radiology in stage directed management.