Sixty patients with esophageal cancer infiltration of mediastinal structures and metastasis to lymph nodes were prospectively evaluated by computed tomography and magnetic resonance imaging and then underwent surgical resection of the tumor (n = 57) or diagnostic thoracotomy (n = 3). Lymph nodes were excised from standardized locations and examined histologically. Sensitivity and specificity of both methods for all criteria were found so low that the value of these methods for planning surgery--or for stratification to different therapeutic arms in comparative studies--must be questioned.