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

Abstract

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

Esophageal carcinoma: Ex vivo evaluation by high‐spatial‐resolution T2‐mapping MRI compared with histopathological findings at 3.0T

“…Computed tomography (CT) has been widely used to identify the location of a cancer, relationship to surrounding organs, and to assess the distant metastasis; however, it cannot depict the specific layer invasion of the esophageal wall due to its poor soft‐tissue resolution . Endoscopic ultrasonography (EUS) can be used to depict the esophageal layers but is restricted by high operator dependency, issues that result from the pathologically stenotic esophageal wall, and its semiinvasive nature . Thus, a more precise and convenient imaging modality is needed to evaluate the esophageal wall invasion by carcinomas.…”

Impact of Endoscopic Ultrasonography on 18F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment

“…Two studies determined the influence of EUS after CT-alone, with a questionnaire, and found that EUS changed the treatment decision in 24–34% of the patients 4,6. A study by Van Zoonen determined that although EUS increased the specificity after CT and ultrasound of the neck, the additional value on determining the surgical resectability was limited 16. Moreover, Findlay et al found that the risk of EUS in T2-4a patients on CT outweighed the additional information of EUS on T- and N-stage 5.…”

Diverse prognostic value of the GTn promoter polymorphism in squamous cell and adeno carcinoma of the oesophagus

“…In future studies with focus on neoadjuvantly treated EC patients, the role of GTn as potential predictor of response may be evaluated. However, considering the fact that present available imaging tools are insufficient to avoid over‐ and undertreatment of the patients because of incorrect disease staging GTn may represent a marker to help therapy decision making .…”