Staging of esophageal cancer by EUS: staging accuracy revisited

• Published in: Gastrointestinal endoscopy Vol. 66; no. 3; pp. 475 - 482
• Main Authors: Shimpi, Rahul A., MD, George, Josh, MD, Jowell, Paul, MD, Gress, Frank G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-09-2007; Elsevier
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Biological and medical sciences; Biopsy; Carcinoma, Neuroendocrine - diagnostic imaging; Carcinoma, Neuroendocrine - pathology; Carcinoma, Neuroendocrine - surgery; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cohort Studies; Digestive system. Abdomen; Endoscopy; Endosonography; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagus; Esophagus - pathology; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Lymphatic Metastasis - pathology; Male; Medical sciences; Neoplasm Invasiveness - pathology; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity; Tumors; high-frequency US; positron emission tomography; gastroesophageal; HFUS; GE; PET; Sonography; Performance evaluation; Human; Endoscopic route; Staging; Endoscopic ultrasonography; Esophageal disease; Malignant tumor; Chemoradiotherapy; Esophagus cancer; Accuracy; Echography; Gastroenterology; Digestive diseases; Predictive factor; Cancer
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.03.1051

Background EUS plays an important role in the preoperative staging of esophageal cancer. Recent data have called into question the staging accuracy of EUS, particularly in patients with early disease. Objective Our goals were to assess our institution's EUS staging accuracy by experienced endosonographers in a contemporary cohort of patients encompassing a wide range of disease stages and to assess staging accuracy after dilation of malignant strictures. Design Retrospective data review. Setting Single tertiary care center. Patients and Interventions A total of 42 patients with esophageal cancer undergoing preoperative EUS staging without neoadjuvant chemoradiotherapy between December 1999 and December 2004 were evaluated. Main Outcome Measurements EUS T and N stage sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Results EUS accurately predicted T stage in 76% of cases and N stage in 89% of cases. Staging accuracy for T3 versus T1 and T2 disease and for N0 versus N1 disease was not significantly different. In 11 cases, malignant strictures required dilation, with 6 tumors being passable post dilation. Post dilation, T staging accuracy was 80% in impassable tumors and 100% in passable tumors, and N staging accuracy was 100% in the passable tumors. Limitations Relatively small number of patients. Conclusions EUS accurately predicts T and N stage in patients with a range of disease stages. EUS provides good staging accuracy after dilation of malignant strictures regardless of whether full tumor traversal post dilation is possible.