Computed tomography overestimation of esophageal tumor length: Implications for radiotherapy planning |
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Authors: | Sillah Karim Williams Luke R Laasch Hans-Ulrich Saleem Azeem Watkins Gillian Pritchard Susan A Price Patricia M West Catharine M Welch Ian M |
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Institution: | Karim Sillah, Ian M Welch, Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom. |
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Abstract: | AIM: To assess the relationship between preoperative computed tomography (CT) and postoperative pathological measurements of esophageal tumor length and the prognostic significance of CT tumor length data.METHODS: A retrospective study was carried out in 56 patients who underwent curative esophagogastrectomy. Tumor lengths were measured on the immediate preoperative CT and on the post-operative resection specimens. Inter- and intra-observer variations in CT measurements were assessed. Survival data were collected.RESULTS: There was a weak correlation between CT and pathological tumor length (r = 0.30, P = 0.025). CT lengths were longer than pathological lengths in 68% (38/56) of patients with a mean difference of 1.67 cm (95% CI: 1.18-2.97). The mean difference in measurements by two radiologists was 0.39 cm (95% CI: -0.59-1.44). The mean difference between repeat CT measured tumor length (intra-observer variation) were 0.04 cm (95% CI: -0.59-0.66) and 0.47 cm (95% CI: -0.53-1.47). When stratified, patients not receiving neoadjuvant chemotherapy showed a strong correlation between CT and pathological tumor length (r = 0.69, P = 0.0014, n = 37) than patients that did (r = 0.13, P = 0.43, n = 19). Median survival with CT tumor length > 5.6 cm was poorer than with smaller tumors, but the difference was not statistically significant.CONCLUSION: Esophageal tumor length assessed using CT does not reflect pathological tumor extent and should not be the only modality used for management decisions, particularly for planning radiotherapy. |
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Keywords: | Computed tomography Esophageal cancer Radiotherapy |
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