Diagnostic Accuracy of Barium Swallow Study for Differentiating Benign and Malignant Esophageal Strictures Using Endoscopy with Biopsy as Gold Standard
DOI:
https://doi.org/10.37762/jgmds.13-4.862Keywords:
Barium Sulfate, Esophageal Stenosis, Esophageal Neoplasms, Deglutition Disorders, Sensitivity and SpecificityAbstract
ABSTRACT
OBJECTIVES
This study aimed to determine the diagnostic accuracy of barium swallow for differentiating malignant from benign oesophageal strictures using endoscopy with biopsy as the reference standard.
METHODOLOGY
This cross-sectional validation study included 88 consecutively selected adults with dysphagia at Rehman Medical Institute from 1 March 2023 to 1 August 2025. Barium swallow and endoscopic biopsy were performed within two weeks. Malignancy was the positive condition. Diagnostic indices, likelihood ratios, Cohen’s kappa and the area under the receiver operating characteristic curve (AUC) were calculated with 95% confidence intervals (CIs).
RESULTS
Biopsy identified 26 malignant and 62 benign strictures. There were eight true positives, 20 false positives, 18 false negatives and 42 true negatives. Sensitivity was 30.8% (95% CI 14.3–51.8), specificity 67.7% (54.7–79.1), positive predictive value 28.6% (13.2–48.7), negative predictive value 70.0% (56.8–81.2) and accuracy 56.8% (45.8–67.3). Positive and negative likelihood ratios were 0.95 (0.48–1.88) and 1.02 (0.75–1.39), respectively. Kappa was −0.015 (−0.222 to 0.193), and binary-score AUC was 0.493 (0.385–0.600). Malignancy remained present in 18/60 benign-appearing examinations (30.0%; 18.8–43.2).
CONCLUSION
Barium classification provided little discrimination and missed most biopsy-confirmed malignancies. A benign-appearing examination should not be used to exclude malignancy or defer indicated endoscopy with biopsy: the small cohort and incomplete masking documentation limit generalisability.
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Copyright (c) 2026 Hira Syed, Aman Nawaz Khan , Ummara Siddique Umer, Muhammad Hasnat, Sara Khattak , Maria Naz, Ashfaq Ahmad
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