Radiologic staging of esophageal and gastroesophageal junction carcinoma

Abstract

Pretreatment radiologic staging can, theoretically, improve the effectiveness and results of surgical treatment in esophageal and gastroesophageal junction carcinoma. Ideally, on these studies it is possible to select only patients with limited local disease for surgery, whereas those with nonresecta.ble tumors or metastases to distant sites are excluded from surgery and submitted to other treatment modalities. The purpose of this study was to evaluate the utility of CT, US and US-guided FNAB for pretreatment staging of esophageal and gastroesophageal junction carcinoma. In assessing distant metastases, these techniques were evaluated at different sites, Because little has been published regarding the examination of supraclavicular lymph nodes in esophageal and gastroesophageal junction carcinoma, a retrospective stndy was first performed to determine the number of patients with squamous cell carcinoma of the intrathoracic esophagus in whom supraclavicular metastases could be demonstrated with us and usguided FNAB (Chapter 2), Subsequently, palpation, CT and US were prospectively evaluated for assessing supraclavicular metastases in patients with either esophageal or gastroesophageal junction carcinoma (Chapter 3). Accuracy of either CT, US, or a combination of both studies, to assess distant metastases in general and at the various sites was determined (Chapter 4). The utility of US-guided FNAB for diagnosing metastases was evaluated (Chapter 5). Assessment of resectability of the primary tnmor was analyzed on CT stndies alone because, generally, this cannot be displayed on US stndies (Chapter 6). Finally a survival analysis was performed to estimate the influence on survival of distant metastases, assessed on US or CT studies, or diagnosed by means of US-guided FNAB and cytologic stndy (Chapter 7)