Prospective comparison of endosonography, computed tomography, and histopathological stage of junctional oesophagogastric cancer

Aims To assess the strength of agreement between the perceived preoperative stage of Siewert II (oesophagogastric junction) and Siewert III (proximal gastric tumours) as determined by computed tomography (CT) and endoscopic ultrasound (EUS), both alone and in combination, with histopathological stage. Methods Forty-four patients with Siewert II ( n = 18) and III ( n = 26) adenocarcinomas of the oesophagogastric junction underwent preoperative CT at their local hospitals followed by specialist EUS, and the strengths of the agreement between the radiological stages and the histopathological stages were determined by the weighted Kappa statistic (Kw). Results Kw for Siewert II T and N stages was 0.491 ( p = 0.016) and 0.4 ( p = 0.087) for CT compared with 0.852 ( p = 0.0001) and 1 ( p = 0.0001) for EUS. Kw for Siewert III T and N stages was 0.181 ( p = 0.206) and 0.121 ( p = 0.376) for CT compared with 0.173 ( p = 0.195) and 0.263 ( p = 0.031) for EUS. Conclusion Siewert II tumour T and N stages were more accurately predicted by EUS than CT, but Siewert III tumour T and N stages were more difficult to assess, arguably because of anatomical constraints at the oesophagogastric junction. CT and EUS are complimentary techniques, and these results highlight the importance of multidisciplinary discussion in planning treatment.