Esophageal cancer diagnostic study of choice
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 performed in 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 result of endoscopic biopsy is a confirmatory of esophageal cancer:
- Friable lesion
- Superficial plaques
- Superfcial nodules
- Superficial ulcerations
- Strictures
- Ulcerated masses
- Circumferential masses
- Large ulcerations
- 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.[1][2]
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 | |
|---|---|---|
| One Endoscopic biopsy | 90% | 95% |
| Four Endosopic biopsies | 95% | 97% |
| Seven Endoscopic biopsies | 98% | 99% |
| With Cytology | 100% | 100% |
Diagnostic results
The following result of endoscopic biopsy is confirmatory of esophageal cancer:
- Friable lesion
- Superficial plaques
- Superfcial nodules
- Superficial ulcerations
- Strictures
- Ulcerated masses
- Circumferential masses
- Large ulcerations
Sequence of Diagnostic Studies
- The esophageal cancer should be performed when:
- The patient presents with symptoms/signs of dysphagia, anemia or weight loss as the first step of diagnosis.
- A positive result is the visualization of an abnormal lesion in the esophagus.
Diagnostic Criteria
- There is no particular established diagnostic criteria for esophageal cancer.
- Diagnosis is based upon history, symptoms and endoscopic biopsy to confirm the diagnosis.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.