Computed Tomography Features and Clinicopathological Characteristics of Resectable Esophageal Sarcomatoid Carcinoma: A Retrospective Study

Meng Li¹Yang Li¹MIngbo Wang²Huiyan Deng³Xiangming Wang^1*Gaofeng Shi^1*Andu Zhang⁴Jialiang Ren⁵

• ¹Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
• ²Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
• ³Department of Pathology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
• ⁴Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
• ⁵GE Healthcare China Co Ltd, Beijing, China

Objectives: Esophageal sarcomatoid carcinoma (ESC) is a rare malignant tumor. This study analyzes the computed tomography (CT) features and clinicopathological characteristics of resectable ESC. Methods: A retrospective analysis was conducted on the CT and clinicopathological data of 25 patients with ESC, confirmed by postoperative pathology. The preoperative CT features included the average tumor CT attenuation value (CTTumor), normal esophagus CT attenuation value (CTNormal), tumor-to-normal esophagus attenuation ratio (TNR), enhancement pattern, tumor margin, and morphology, classified into mass-forming type and wall-thickening type. Additionally, CT-measured tumor thickness (cTT), length (cTL), and volume (cTV) were documented. Clinicopathological characteristics included age, gender, clinical symptoms, pathological tumor thickness (pTT), length (pTL), T stage, N stage, lymphovascular invasion, and neural invasion status. Bland-Altman plots and Pearson correlation coefficient analyses were performed to assess agreement between CT features and pathological results. Results: Among the 25 patients, 19 were male and 6 female, with ages ranging from 47 to 73 years (mean 65.48 ± 6.85 years). Pathological staging revealed 14 cases at T1, 5 at T2, 5 at T3, and 1 at T4. Lymph node metastasis was identified in 12 cases (5 N1, 4 N2, 3 N3). The pTT ranged from 0.50 to 4.00 cm (mean 1.92 ± 1.02 cm), while cTT ranged from 0.60 to 4.10 cm (mean 2.02 ± 0.90 cm). Bland-Altman analysis showed a mean difference of 0.10 cm between cTT and pTT, with 92.0% of cases within the 95% limits of agreement. The Pearson correlation coefficient was 0.980. The pTL ranged from 2.00 to 7.00 cm (mean 4.24 ± 1.50 cm), and cTL from 2.57 to 7.50 cm (mean 4.41 ± 1.48 cm). A mean difference of 0.18 cm was found between cTL and pTL, with a Pearson correlation coefficient of 0.884. The cTV ranged from 1.56 cm³ to 41.49 cm³ (median 8.25 cm³). Tumor morphology revealed 20 cases as mass-forming type and 5 as wall-thickening type, with significant differences in pTT and cTT between types. Conclusion:ESC is characterized by distinctive CT features, predominantly as mass-forming type, with diagnosis reliant on pathological examination.