CARCINOMA OF THE ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION - SENSITIVITYOF RADIOGRAPHIC DIAGNOSIS

OBJECTIVE. The purpose of this study was to determine the sensitivity of barium studies in revealing carcinoma of the esophagus and esophago gastric junction. MATERIALS AND METHODS, We retrospectively reviewed 5 0 cases of squamous cell carcinoma of the esophagus (n = 25) and adeno carcinoma of the esophagus (n = 14) or esophagagastric junction (n = 1 1) in which double-contrast (n = 46) or single-contrast (n = 4) barium studies had been done. The original radiology reports were reviewed t o determine whether the lesions had been seen on barium studies and wh ether cancer had been diagnosed, Records were also reviewed to determi ne the number of patients who underwent esophageal endoscopy because o f findings suggestive of cancer on barium studies at some point from J anuary 1992 through December 1992. Pathology records were then reviewe d to determine the number of true- and false-positive barium studies d uring this same period, RESULTS, Lesions were shown on barium studies in 49 (98%) of 50 patients, and carcinoma of the esophagus or esophago gastric junction was diagnosed or suspected in 48 patients (96%). In a separate part of the study, we found that endoscopy had been recommen ded to rule out malignant tumor in only 26 (1%) of 2484 patients who u nderwent barium studies at some point from January 1992 through Decemb er 1992. Endoscopy revealed cancer in 11 of those 26 patients; the rem aining 15 were assumed to have false-positive radiologic examinations. Barium studies therefore had a positive predictive value of 42%. CONC LUSION. The double-contrast barium study is a sensitive technique for the diagnosis of carcinoma of the esophagus and esophagogastric juncti on. This high sensitivity can be achieved while recommending endoscopy in only about 1% of all patients who undergo barium studies.