Evaluation of Siewert classification in gastro‐esophageal junction adenocarcinoma: What is the role of endoscopic ultrasonography?

Pedrazzani, Corrado; Bernini, Marco; Giacopuzzi, Simone; Pugliese, Raffaele; Crea, Filippo; Festini, Filippo; Rodella, Luca; Manzoni, Giovanni De

doi:10.1002/jso.20302

Cited by 31 publications

(17 citation statements)

References 22 publications

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“…In total, 31 articles on EUS for regional lymph node metastases (Tio et al, 1990;Botet et al, 1991;Rice et al, 1991;Ziegler et al, 1991;Dittler and Siewert, 1993;Grimm et al, 1993;Greenberg et al, 1994;Yoshikane et al, 1994;Binmoeller et al, 1995;Hasegawa et al, 1996;Hunerbein et al, 1996;Natsugoe et al, 1996;Pham et al, 1998;Vickers, 1998;Bowrey et al, 1999;Catalano et al, 1999;Nishimaki et al, 1999;Salminen et al, 1999;Choi et al, 2000;Nesje et al, 2000;Richards et al, 2000;Shinkai et al, 2000;Vazquez-Sequeiros et al, 2001Rasanen et al, 2003;Wu et al, 2003;Heeren et al, 2004;Sihvo et al, 2004;DeWitt et al, 2005;Lowe et al, 2005;Pedrazzani et al, 2005) and five articles on EUS for celiac lymph node metastases were included (Binmoeller et al, 1995;Catalano et al, 1999;Eloubeidi et al, 2001;Vazquez-Sequeiros et al, 2001;Parmar et al, 2002) (Table 1). For CT, the literature search gave 1091 hits.…”

Section: Literature Search and Data Extractionmentioning

confidence: 99%

Staging investigations for oesophageal cancer: a meta-analysis

et al. 2008

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The aim of the study was to compare the diagnostic performance of endoscopic ultrasonography (EUS), computed tomography (CT), and 18 F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in staging of oesophageal cancer. PubMed was searched to identify English-language articles published before January 2006 and reporting on diagnostic performance of EUS, CT, and/or FDG-PET in oesophageal cancer patients. Articles were included if absolute numbers of true-positive, false-negative, falsepositive, and true-negative test results were available or derivable for regional, celiac, and abdominal lymph node metastases and/or distant metastases. Sensitivities and specificities were pooled using a random effects model. Summary receiver operating characteristic analysis was performed to study potential effects of study and patient characteristics. Random effects pooled sensitivities of EUS, CT, and FDG-PET for regional lymph node metastases were 0. .86 -0.96) for CT, respectively. Diagnostic performance of FDG-PET for distant metastases was significantly higher than that of CT, which was not significantly affected by study and patient characteristics. The results suggest that EUS, CT, and FDG-PET each play a distinctive role in the detection of metastases in oesophageal cancer patients. For the detection of regional lymph node metastases, EUS is most sensitive, whereas CT and FDG-PET are more specific tests. For the evaluation of distant metastases, FDG-PET has probably a higher sensitivity than CT. Its combined use could however be of clinical value, with FDG-PET detecting possible metastases and CT confirming or excluding their presence and precisely determining the location(s).

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Section: Literature Search and Data Extractionmentioning

confidence: 99%

Staging investigations for oesophageal cancer: a meta-analysis

et al. 2008

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“…Nowadays the terminology used for the definition of adenocarcinomas at the GE junction is "cardiac carcinoma", which can be easily misunderstood. This definition of adenocarcinomas of the GE junction does not allow correct comparison of diagnosis (endoscopic, radiological and pathologic), epidemiology and surgical therapy in national and international aspects, because different tumor can develop in the same area, and all called cardia tumors [20] . Siewert and Stein recommended a classification to solve this problem [21] .…”

Section: Introductionmentioning

confidence: 99%

“…Type Ⅱ is adenocarcinoma of the real cardia and type Ⅲ is subcardial gastric adenocarcinoma. The importance of this classification is it enables unified pre-operative assessment and it can also help to decide the type of the surgical intervention [20,[23][24][25][26][27] .…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of esophageal cancer

Zhang¹

2013

WJG

891

749

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Esophageal cancer (EsC) is one of the least studied and deadliest cancers worldwide because of its extremely aggressive nature and poor survival rate. It ranks sixth among all cancers in mortality. In retrospective studies of EsC, smoking, hot tea drinking, red meat consumption, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with a higher risk of esophageal squamous cell carcinoma. Barrett's esophagus is clearly recognized as a risk factor for EsC, and dysplasia remains the only factor useful for identifying patients at increased risk, for the development of esophageal adenocarcinoma in clinical practice. Here, we investigated the epidemiologic patterns and causes of EsC. Using population based cancer data from the Surveillance, Epidemiology and End Results Program of the United States; we generated the most up-to-date stage distribution and 5-year relative survival by stage at diagnosis for 1998-2009. Special note should be given to the fact that esophageal cancer, mainly adenocarcinoma, is one of the very few cancers that is contributing to increasing death rates (20%) among males in the United States. To further explore the mechanism of development of EsC will hopefully decrease the incidence of EsC and improve outcomes.© 2013 Baishideng. All rights reserved.Key words: Risk factor; Barrett's esophagus; Cyclin D1 G870A; Esophageal neoplasm; Susceptibility; Polymorphism Core tip: Here, we investigated the epidemiologic patterns and causes of esophageal cancer. Using population based cancer data from the Surveillance, Epidemiology and End Results Program of the United States; we generated the most up-to-date stage distribution and 5-year relative survival by stage at diagnosis for

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“…Total gastrectomy instead of esophagectomy may be an alternative surgical approach to Siewert type II-III tumors [2]. EUS combined with endoscopy may assist in determining the Siewert classification, although data on this are scarce [23].…”

Section: Discussionmentioning

confidence: 99%

“…Pedrazzani et al [23] showed that the sensitivity and specificity for preoperative staging of Siewert type I cancers with a combination of endoscopy and EUS were 90 and 82 %, respectively, whereas these scores decreased to 75 and 69 %, respectively, when only endoscopy was performed. Distinguishing type II from type III lesions seemed even more difficult with sensitivities well below 75 %.…”

Section: Discussionmentioning

confidence: 99%

Low impact of staging EUS for determining surgical resectability in esophageal cancer

et al. 2012

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Background Although studies have shown that EUS has a high sensitivity and specificity for T and N staging, the value of EUS for staging tumors as resectable or nonresectable after CT of the chest and abdomen and US neck assessment, is largely unknown. This study was designed to assess the diagnostic value of EUS for determining resectability of esophageal cancer. Methods A retrospective analysis of all consecutive patients with esophageal carcinoma who underwent staging EUS, CT, and US. Tumors were considered resectable when there was no evidence of metastases or ingrowth in adjacent structures. Sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of CT/US neck and CT/US neck ? EUS for predicting surgical resectability were calculated. PPVs of CT/US alone and CT/US ? EUS together were compared for assessing the diagnostic value of EUS. Results In total, 211 patients (155 men; mean age of 64 ± 9.4 years) were included, of which 176 (83 %) underwent all three staging investigations. Based on preoperative staging, 173 (82 %) patients were considered resectable and 38 (18 %) nonresectable. Of all 173 initially resectable patients, 145 were operated on. Of these patients, five (3.4 %) tumors were found nonresectable during surgery. Postoperative sensitivity, specificity, PPV, and NPV of CT/US and CT/US ? EUS for predicting surgical resectability were 88 versus 87 %, 20 versus 40 %, 97 versus 98 %, and 6 versus 10 %, respectively. Conclusions Although EUS adds to the specificity of preoperative esophageal cancer staging after CT chest and abdomen, and US of the neck have been performed, the overall added value of EUS is limited. Keywords Esophageal cancer Á Endoscopic ultrasonography Á Surgical resectabilityApproximately 50 % of patients with esophageal cancer present with potentially resectable disease [1]. Current guidelines recommend computed tomography (CT) of the chest and abdomen, ultrasonography (US) of the neck, and endoscopic ultrasonography (EUS) for staging of esophageal cancer [2][3][4]. Although CT of the chest and abdomen and US of the neck are primarily used for the detection of distant metastases, EUS provides information on local resectability (T stage) and locoregional lymphadenopathy (N stage) [5,6].One of the main goals of esophageal cancer staging is to select patients who are suitable for surgical resection of the tumor, because surgery remains the best curative option for

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Evaluation of Siewert classification in gastro‐esophageal junction adenocarcinoma: What is the role of endoscopic ultrasonography?

Abstract: EUS seems to be essential in differentiating pT1 from advanced tumors. It shows an accuracy in defining the Siewert type of 72.5%, with some difficulties in distinguishing from type II and III tumors.

Cited by 31 publications

References 22 publications

Staging investigations for oesophageal cancer: a meta-analysis

Staging investigations for oesophageal cancer: a meta-analysis

Epidemiology of esophageal cancer

Low impact of staging EUS for determining surgical resectability in esophageal cancer

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