IMAGING OF CANCER OF THE ESOPHAGUS - ECHO ENDOSCOPY OR TOMODENSITOMETRY

The aim of this retrospective study, in 100 patients who had an esopha gectomy from 1987 to 1992 for squamous cell carcinoma of the thoracic esophagus, was to determine the accuracy of endoscopic ultrasonography (EUS) and computed tomography (CT) in the preoperative staging of eso phageal squamous cell carcinoma (SCC). The EUS report were compared to the pathological findings for the T stage. Both EUS and CT reports we re compared with surgical and pathological findings for N stage (N0/N1 ) and mediastinal extension. In the 100 patients, EUS accuracy for T s tage was 80 %; EUS was more accurate for N stage than CT (71 % vs 55 % respectively; p < 0.02), and as accurate as CT for mediastinal extens ion (86 % vs 85 %). In the 26 SCC estimated superficial by EUS (all pa ssed through), EUS accuracy was 92 % for T stage and 77 % for the dist inction between mucosal and submucosal tumours; for N stage, EUS and C T accuracies were equivalent (77 % vs 81 %). In the 44 SCC passed and estimated advanced by EUS, EUS accuracy for T stage was 68 %; EUS was more accurate than CT for N stage (77 % vs 48 %, p < 0,01) and as accu rate as CT for mediastinal extension (86 vs 84 %). In the 30 SCC not p assed by EUS, accuracies of EUS and CT were equivalent for N stage (57 % vs 47 %) and for mediastinal extension (73 % vs 73 %). This study s uggests that: a) for SCC estimated superficial by EUS, EUS does not di fferentiate reliably mucosal from submucosal tumors and CT is useless; b) routine EUS seems unnecessary for SCC not passed through by endosc opy; c) CT is still useful in patients with advanced SCC, mainly for d etection of distant metastases.