In order to determine the accuracy of computed tomographic (CT) scanning, CT scan results were compared with operative and pathologic findings in 45 patients with esophageal and proximal gastric malignancies. CT scans were evaluated with respect to nodal metastases, hepatic metastases, and adjacent spread. Eight patients did not undergo surgery because of advanced disease noted on the CT scan. Of the remaining 37 patients, sensitivity of CT for all 3 parameters was less than 60%, whereas the specificity was greater than 90%. The positive predictive value was greater than 90% for nodal metastases and adjacent spread and 67% for hepatic metastases. The negative predictive value was less than 40% for nodal metastases and adjacent spread and 90% for hepatic metastases. For esophageal and proximal gastric malignancies, CT is useful in identifying advanced disease and in predicting resectability. In less advanced cases, CT is not sensitive, and its negative predictive value is poor with regard to local and lymphatic spread. CT scanning is useful to stage the most advanced cases but because of limited accuracy should be combined with other diagnostic studies when accurate staging is required.