Staging Accuracy of Computed Tomography and Endoscopic Ultrasound in Preoperative Staging of Esophageal Cancer: Results of an Referral Center

Abstract

Introduction: Preoperative staging is the main prognostic factor and is crucial in therapeutic selection of esophageal cancer.

Aim: Evaluate computerized tomography and endoscopic ultrasonography accuracy in preoperative esophageal cancer staging.

Methods: A retrospective study between 1/1/2010 and 30/9/2015 was performed. Sensibility, specificity, positive and negative predictive values, and accuracy for T and N stage was calculated. Using the Cohen weighted K, the degree of concordance between the exams and anatomopathological results was assessed.

Results: Computerized tomography and endoscopic ultrasonography presented an accuracy of 35.7% (95%CI, 17.9-53.4) and 64.3% (95%CI, 46.5-82) for T, and 57.1% (95%CI, 38.8-75.4) and 71.4% (95%CI, 54.6-88.1) for N. Computerized tomography presented an sensibility, specificity, positive and negative predictive values of 12.5%(95%CI, 0.32-52.6), 85%(95%CI, 62.1-96.8), 25%(95%CI, 0.63-80.6), 70.8%(95%CI, 48.9-87.4) for T1; 33.3%(95%CI, 4.3-77.7), 68.2%(95%CI, 45.1-86.1), 22.2%(95%CI, 2.8-60), 78.9%(95%CI, 54.4-93.9) for T2; 50%(95%CI, 23-77), 57.1%(95%CI, 28.9-82.3), 53.8%(95%CI, 25.1-80.8), 53.3%(95%CI, 26.6-78.1) for T3; 30%(95%CI, 6.67-65.25), 72.2%(95%CI, 46.5-90.3), 37.5%(95%CI, 8.5-75.5), 65%(95%CI, 40.8- 84.6) for N. For endoscopic ultrasonography: 62.5%(95%CI, 0-40.96), 95%(95%CI, 75.1-99.9),83.3%(95%CI, 35.9-99.6), 86.4%(95%CI, 65.1-97.1) for T1; 50%(95%CI, 11.8-88.2), 77.3%(95%CI, 54.6- 92.2), 37.5%(95%CI, 8.5-75.6), 85%(95%CI, 62.1-96.8) for T2; 71.4%(95%CI, 41.9-91.6), 71.4%(95%CI, 41.9-91.6), 71.4%(95%CI, 41.9-91.6), 71.4%(95%CI, 41.9-91.6) for T3; 90%(95%CI, 55.5-99.7), 61.1%(95CI, 35.7-82.7), 56.2%(95%CI, 29.9-80.2), 92%(95%CI, 62.5-99.8) for N. Concordance was poor for computerized tomography and moderate for endoscopic ultrasonography.

Conclusions: Endoscopic ultrasonography has a better accuracy in esophageal cancer staging, for T and N, showing a high sensibility, specificity, positive and negative predictive values, with a better accuracy for T3. Only endoscopic ultrasonography showed a significant relationship with an atom pathological results (p<0.05).