STAGING OF ESOPHAGEAL CANCER - COMPUTED-TOMOGRAPHY, MAGNETIC-RESONANCE-IMAGING, AND ENDOSCOPIC ULTRASOUND

CT and EUS are complimentary modalitiesthat allow accurate esophageal cancer staging. To prevent unnecessary surgical interventions, patients should undergo selective imaging tests before curative resection is attempted or palliative protocols are implemented (Fig 6). An acceptable strategy for evaluating a newly diagnosed esophageal cancer patient begins with a CT of the mediastinum and abdomen. If distant metastases (such as liver lesions) are detected, or definite local organ invasion is found (such as invasion of the trachea, bronchus, or pericardium), no further imaging tests are required, and palliative therapy should be initiated. If CT imaging is inconclusive or negative for metastases or frank local invasion, an EUS examination should be performed to define the extent of local invasion and regional lymph node metastases. Chemotherapy and radiation therapy should be considered in patients with T3, T4, and/or N1 disease. Shorter imaging times and improved contrast agents should further improve the accuracy and utility of CT and MRI. Additional technical advances, including a wider range of scanning frequencies, Doppler, and thinner scopes, should improve the application of EUS. © 1994 W.B. Saunders Company. All rights reserved.