Esophageal cancer diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
Esophageal cancer is best diagnosed using an endoscope to visualize the esophageal lesion, followed by a biopsy to confirm the diagnosis. These are done within the same sitting.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
=== Gold standard/Study of choice: ===
* Endoscopic biopsy is the gold standard test for the diagnosis of esophageal cancer.
* The following visualisation on endoscopic biopsy is seen in esophageal cancer:
**superficial plaques
**superfcial nodules
**superficial ulcerations
**strictures
**ulcerated masses
**circumferential masses
**large ulcerations<ref name="pmid9934727">{{cite journal |vauthors=Lightdale CJ |title=Esophageal cancer. American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=94 |issue=1 |pages=20–9 |year=1999 |pmid=9934727 |doi=10.1111/j.1572-0241.1999.00767.x |url=}}</ref><ref name="pmid19117343">{{cite journal |vauthors=Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA |title=Esophageal tumor length is independently associated with long-term survival |journal=Cancer |volume=115 |issue=3 |pages=508–16 |year=2009 |pmid=19117343 |doi=10.1002/cncr.24062 |url=}}</ref>


=== Gold standard/Study of choice: ===
Even though large masses seen in the esophagus are almost pathognomonic for esophageal cancer, the diagnosis of squamous cell carcinoma or adenocarcinoma esophageal cancer is confirmed by biopsy.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
==== The comparison table for diagnostic studies of choice for esophageal cancer ====
 
*Studies have found that the greater the number of biopsies taken (up to seven), the higher the diagnostic accuracy. The addition of brush cytology specimens to seven biopsies increased the accuracy to 100%.<ref name="pmid7054024">{{cite journal |vauthors=Graham DY, Schwartz JT, Cain GD, Gyorkey F |title=Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma |journal=Gastroenterology |volume=82 |issue=2 |pages=228–31 |year=1982 |pmid=7054024 |doi= |url=}}</ref>
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<small> ✔= The best test based on the feature </small>
<small> ✔= The best test based on the feature </small>
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Revision as of 15:20, 12 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

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Overview

Esophageal cancer is best diagnosed using an endoscope to visualize the esophageal lesion, followed by a biopsy to confirm the diagnosis. These are done within the same sitting.

Diagnostic Study of Choice

=== Gold standard/Study of choice: ===
  • Endoscopic biopsy is the gold standard test for the diagnosis of esophageal cancer.
  • The following visualisation on endoscopic biopsy is seen in esophageal cancer:
    • superficial plaques
    • superfcial nodules
    • superficial ulcerations
    • strictures
    • ulcerated masses
    • circumferential masses
    • large ulcerations[1][2]

Even though large masses seen in the esophagus are almost pathognomonic for esophageal cancer, the diagnosis of squamous cell carcinoma or adenocarcinoma esophageal cancer is confirmed by biopsy.

The comparison table for diagnostic studies of choice for esophageal cancer

  • Studies have found that the greater the number of biopsies taken (up to seven), the higher the diagnostic accuracy. The addition of brush cytology specimens to seven biopsies increased the accuracy to 100%.[3]
Sensitivity Specificity
Test 1 ✔ ...%
Test 2 ...% ✔

✔= The best test based on the feature

References

  1. ↑ Lightdale CJ (1999). "Esophageal cancer. American College of Gastroenterology". Am. J. Gastroenterol. 94 (1): 20–9. doi:10.1111/j.1572-0241.1999.00767.x. PMID 9934727.
  2. ↑ Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA (2009). "Esophageal tumor length is independently associated with long-term survival". Cancer. 115 (3): 508–16. doi:10.1002/cncr.24062. PMID 19117343.
  3. ↑ Graham DY, Schwartz JT, Cain GD, Gyorkey F (1982). "Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma". Gastroenterology. 82 (2): 228–31. PMID 7054024.


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