American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred initial diagnostic test for suspected esophageal cancer?

1. X-ray of the esophagus

2. CT scan of the abdomen

3. Upper endoscopy with biopsy

4. Esophageal manometry

The correct answer is: Upper endoscopy with biopsy

The preferred initial diagnostic test for suspected esophageal cancer is upper endoscopy with biopsy. This procedure is essential because it allows direct visualization of the esophagus, enabling the clinician to identify any abnormal lesions or growths. Moreover, the ability to perform a biopsy during the endoscopy provides definitive histological evaluation, confirming the presence of cancerous cells. Upper endoscopy is favored due to its high sensitivity and specificity for detecting esophageal tumors, especially in the context of unexplained symptoms such as dysphagia or weight loss. The direct sampling of tissue during this procedure is a critical step in accurately diagnosing esophageal cancer. While other imaging tests such as X-rays or CT scans can provide information about the anatomy and any potential mass effect caused by tumors, they do not offer the same level of detail regarding the mucosal surface or definitive histological evidence. Esophageal manometry is primarily used to assess function and motility rather than to diagnose structural abnormalities such as cancer. Thus, among the options, upper endoscopy with biopsy stands out as the most effective method for initial diagnosis of suspected esophageal cancer.