Sillah K, Williams LR, Laasch HU, Saleem A, Watkins G, Pritchard SA, Price PM, West CM, Welch IM. Computed tomography overestimation of esophageal tumor length: Implications for radiotherapy planning. World J Gastrointest Oncol 2010; 2(4): 197-204 [PMID: 21160598 DOI: 10.4251/wjgo.v2.i4.197]
Corresponding Author of This Article
Catharine M West, Professor, School of Cancer & Enabling Sciences, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom. catharine.west@manchester.ac.uk
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World J Gastrointest Oncol. Apr 15, 2010; 2(4): 197-204 Published online Apr 15, 2010. doi: 10.4251/wjgo.v2.i4.197
Computed tomography overestimation of esophageal tumor length: Implications for radiotherapy planning
Karim Sillah, Luke R Williams, Hans-Ulrich Laasch, Azeem Saleem, Gillian Watkins, Susan A Pritchard, Patricia M Price, Catharine M West, Ian M Welch
Karim Sillah, Ian M Welch, Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
Karim Sillah, Azeem Saleem, Gillian Watkins, Patricia M Price, Catharine M West, School of Cancer & Enabling Sciences, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom
Luke R Williams, Department of Radiology, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
Hans-Ulrich Laasch, Department of Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
Susan A Pritchard, Department of Histopathology, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
Author contributions: Welch IM, West CM, Saleem A and Price PM conceived the idea; Sillah K, Williams LR, Pritchard SA and Watkins G collected the data; Williams LR and Laasch HU scored the CTs; Sillah K drafted the initial manuscript and all the co-authors contributed to subsequent drafts.
Supported by The local departmental research fund
Correspondence to: Catharine M West, Professor, School of Cancer & Enabling Sciences, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom. catharine.west@manchester.ac.uk
Telephone: +44-161-4468275 Fax: +44-161-4468111
Received: May 5, 2009 Revised: February 22, 2010 Accepted: March 1, 2010 Published online: April 15, 2010
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.
