Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer

Background. Exact clinical staging before treatment of esophageal cancer ha s become increasingly important in the evaluation and comparison of the res ults of different treatment modalities, including surgery, chemotherapy, an d radiotherapy. Methods. The accuracy of preoperative tumor staging by using an esophagogra phy, esophagoscopy, percutaneous and endoscopic ultrasonography, and comput ed tomography was assessed in 224 patients with resectable esophageal cance r. The results of tumor staging by these tests were compared prospectively with the pathologic stage of the esophagectomy specimens with respect to th e T and N categories defined by the International Union Against Cancer TNM classification. Results. For the T category, the overall accuracy was 80%. For the N catego ry, overall accuracy was 72%, with a sensitivity of 78%, a specificity of 6 0%, and a positive predictive value of 78%. Overall, the accuracy of stage grouping was 56%. Conclusions. Either the T or N categories can be predicted reliably by clin ical staging techniques. However, the preoperative stage grouping might not be valid in resectable, localized esophageal cancer. (C) 1999 by The Socie ty of Thoracic Surgeons.