Computed tomographic staging of esophageal carcinoma: a study on interobserver variation and correlation with pathological findings

Despite numerous reports on the efficacy of CT in the staging of esophageal carcinoma, no data are available on the reproducibility of the procedure. Three experienced radiologists independently reviewed the CT scans of 35 patients retrospectively. Calculation of interobserver variation was performed using the κ statistic. The CT findings of each observer were subsequently correlated with the surgical and pathological findings of 17 patients. There was a large interobserver variation concerning involvement of the aorta, pulmonary vessels, vertebral column, stomach and lymph nodes, ranging from poor to excellent agreement. Agreement between observers on extension of the disease to the tracheobronchial tree, pericardium and liver was good or excellent. Agreement between the CT findings of all observers and the surgical findings for invasive growth was poor. CT pathological correlation of the three observers showed sensitivities ranging from 50 to 57%, specificities ranging from 50 to 60% and accuracies ranging from 46 to 71%. It can be concluded from this study that patients with positive CT findings for involvement of the tracheobronchial tree, the pericardium and the liver should be considered unresectable for cure. Negative findings, however, should be interpreted with caution, because involvement of other structures may still be present. Despite optimistic reports on the efficacy of CT in the pretherapy staging of esophageal neoplasms, this modality has its limitations.