Evaluation of local invasion by oesophageal carcinoma
a
prospective study of prone computed tomography scanning
J Waymana, S Chakravertyb, S M Griffina, G J Doyleb, M J Keirc, W Simpsonb
a Royal
Victoria Infirmary, Newcastle upon Tyne, UK: Northern Oesophago-Gastric
Cancer Unit, b Department of Radiology, c Department
of Medical Physics
Correspondence to: and requests for reprints to: Professor S Michael Griffin, Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK S.M.Griffin{at}ncl.ac.uk
Submitted 30 November
1999;
Accepted 6 June 2000
The aim of this study was to assess the value of prone computed
tomography compared with the traditional supine position, in the
assessment of invasion of adjacent mediastinal structures by
oesophageal cancer. A prospective, single blind case-case comparative study of signs of local tumour invasion was conducted. Sixty nine consecutive patients undergoing computed tomography for preoperative staging of oesophageal carcinoma were studied. Computed tomography scanning of the thorax was performed in the standard supine followed by
prone position; in 39 patients the computed tomography findings were correlated with the surgical findings. Four established
radiological signs used to assess mediastinal invasion were scored in
each case.
Based on the radiological scoring system, there was a significant
down staging in the probability of aortic invasion in 12 of the 69 cases (p<0.05). A similar improvement in accuracy was seen in the
cases undergoing surgery; of the 38 cases who did not have aortic
invasion at operation, 10 cases were scored as high for aortic invasion
on the supine scans compared with only three on the prone position
(p<0.05). Prone scanning was not of significant additional value in
the assessment of major airway or pericardial invasion.
Modification of the computed tomography protocol to include scanning in
the prone position will improve the accuracy of the preoperative
staging of patients with oesophageal malignancy and reduce the chance
of overstaging disease. Especially in centres where endoscopic
ultrasound is not available, our modification may reduce the chance of
denying patients potentially curative operations.
Keywords: computed tomography; neoplasm staging; oesophageal neoplasm; local invasion
© 2001 by The Fellowship of Postgraduate Medicine
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