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Preliminary Diagnosis: Squamous Cell Carcinoma of the Esophagus
I. What imaging technique is first-line for this diagnosis?
Fluoroscopic guided double contrasted esophagram.
II. Describe the advantages and disadvantages of this technique for diagnosing squamous cell carcinoma of the esophagus.
Advantages
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Highly portable, relative quick imaging modality.
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Double contrast esophagraphy offers exquisite detail of the esophageal mucosa.
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Highly sensitive.
Disadvantages
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Less specific in a detecting primary esophageal neoplasm compared to other imaging modalities.
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May expose patients to large amounts of ionizing radiation.
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Limited in detecting the depth and extent of spread of an esophageal neoplastic process.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to fluoroscopic imaging exist.
IV. What alternative imaging techniques are available?
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CT of the chest and abdomen with IV contrast.
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MR imaging of the chest and abdomen.
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Endoscopic ultrasound.
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PET/CT imaging.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing squamous cell carcinoma of the esophagus.
CT of the Chest and Abdomen with IV contrast
Advantages
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Highly sensitive and specific in detecting the depth of invasion and extent of invasion of a primary esophageal neoplasm.
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Highly adept in staging an esophageal neoplasm by helping localize and characterize any metastatic lymphadenopathy.
Disadvantages
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Exposes patients to ionizing radiation.
MR imaging of the chest and abdomen
Advantages
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Offers exquisite detail of the surrounding soft tissues.
Disadvantages
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Expensive.
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Time consuming.
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May be subject to motion artifact, limiting sensitivity of the exam.
Endoscopic ultrasound
Advantages
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Better evaluates the depth of the primary lesion than other imaging modalities.
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Does not expose patients to ionizing radiation.
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Highly portable.
Disadvantages
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Invasive procedure
PET/CT imaging
Advantages
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Offers exquisite anatomical and functional imaging capabilities.
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Highly sensitive and specific in detecting regional and distant metastasis.
Disadvantages
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Lengthy imaging modality.
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Exposure to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
CT of the chest and abdomen with IV contrast
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May be contraindicated in pregnant patients.
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May be contraindicated in patients with renal failure or contrast allergy.
MR imaging of the chest and abdomen
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May be contraindicated in patients with non-MR compatible hardware.
Endoscopic ultrasound
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No specific contraindications to endoscopic ultrasound exist.
PET/CT imaging
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Contraindicated in pregnant patients and those that are breastfeeding.
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