Accuracy of Endoscopic Ultrasonography in Preoperative Staging of Esophageal Carcinoma

Abstract

Background: With the advent of stage-adapted multimodal regimens for many gastrointestinal malignancies, accurate staging has become of utmost importance. In esophageal cancer, endoscopic ultrasonography (EUS) emerged as standard to determine T and N stage. Objective: Since growth patterns of squamous carcinoma (SC) differs from adenocarcinoma (AC) and lymph nodes are located at various distances from the esophagus in a horizontal plane, we studied the accuracy of esophageal EUS as a function of tumor type and localization of the tumor within the esophagus. Results: Overall staging accuracy was 79% for T and for N staging. Staging was more accurate for T3/4, when compared to T1/2 tumors, and for SC when compared to AC. Histological T1/2 stages were overstaged by EUS in 8/17 patients, mostly in patients with AC (6/10). The sensitivity of retrosternal pain and of dysphagia for extramural disease was 57 and 92% respectively, the specificity of pain for extramural disease was 73%, and of dysphagia 36%. Preoperative weight loss in this series correlated linearly with tumor stages. Conclusions: The accurate preoperative staging of T2 esophageal endodermal malignancies is crucial for treatment stratification but difficult to achieve by visual analysis of endosonography alone. Postacquisition processing of echoendosonographic images might further increase the accuracy of echoendosonography and aid in the critical differentiation of T2 versus T3 esophageal malignancies. Preoperative weight loss and retrosternal pain are good clinical indicators of extramural disease.

Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review

“…For T staging, there were 43 studies [10,18,[20][21][22][23][24] . There were 44 studies for nodal staging [10,18,[20][21][22][23][24][38][39][40][41][42][43][44][45][46][48][49][50]53,54,[56][57][58][59][60][61][62][63][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] , and of these, 4 used FNA for nodal staging [23,…”

Celiac Node Failure Patterns After Definitive Chemoradiation for Esophageal Cancer in the Modern Era

“…For esophageal tumors, the use of EUS-FNA in addition to PET has greatly improved the ability to identify nodes suspected of harboring disease, including those in the celiac axis (19), with accuracy rates as high as 98% (95% CI 90%–100%) (18). With these improvements in imaging, radiation coverage of celiac nodes can potentially be reserved for those patients with suspected or proven involvement of lymph nodes, for those with more distal esophageal tumors, and perhaps for those with N1 or greater initial staging, as such patients may be more likely to experience distant failure.…”

Endoscopic Ultrasound with Conventional Probe and Miniprobe in Preoperative Staging of Esophageal Cancer

“…2,11 EUS, especially in combination with fine-needle aspiration (FNA), is the most accurate method for assessing the locoregional extent of esophageal carcinomas. 6,[14][15][16]30 EUS staging has been found to significantly alter the management strategy of patients with esophageal cancer with increased referral for nonsurgical palliation. 17 However, one limitation of conventional EUS is the inability to pass stenotic tumors making the complete assessment by conventional EUS probes impossible.…”

“…8,15 One possible reason for this finding is the anatomically complex region with its curved area between the esophagus and stomach making the exact depth of tumor invasion more difficult to measure. 8 In the present study, we did not find a deterioration of staging accuracy for tumors of the esophagogastric junction.…”