Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT.

Abstract

Fifty patients with esophageal cancer proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US); in 42 of the patients, dynamic CT of the chest and abdomen was also performed. All results were compared with the findings at pathologic examination of resected specimens. In staging the depth of tumor growth, endoscopic US was significantly more accurate (46 of 50 tumors [92%]) than CT (25 of 42 tumors [60%]) (P less than .0003). In staging regional lymph nodes, it was more accurate (44 of 50 patients [88%]) than CT (31 of 42 patients [74%]), but this was not statistically significant. In staging distant metastases, however, CT was more accurate (38 of 42 patients [90%]) than endoscopic US (35 of 50 patients [70%]) (P less than .016). The highest concordance with surgical and pathologic findings in overall stage (36 of 42 tumors [86%]) occurred with the combined use of CT and endoscopic US, which was significantly more accurate than use of CT alone (27 of 42 tumors [64%]) (P less than .008).

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

“…Fortynine studies (n = 2558) which met the inclusion criteria were included in this analysis [10,18,[20][21][22][23][24][38][39][40] . For T staging, there were 43 studies [10,18,[20][21][22][23][24] .…”

Staging investigations for oesophageal cancer: a meta-analysis

“…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.…”

“…For CT, the literature search gave 1091 hits. Seventeen articles on CT for regional lymph node metastases met the inclusion criteria (Quint et al, 1985;Botet et al, 1991;Ziegler et al, 1991;Sondenaa et al, 1992;Greenberg et al, 1994;Yoshikane et al, 1994;Flanagan et al, 1997;Nishimaki et al, 1999;Choi et al, 2000;Wren et al, 2002;Rasanen et al, 2003;Vazquez-Sequeiros et al, 2003;Wu et al, 2003;Yoon et al, 2003;Heeren et al, 2004;Sihvo et al, 2004;Lowe et al, 2005). As some articles containing the results of CT not only reported on celiac lymph node metastases, but also on other abdominal lymph node metastases, we decided to include all articles (five in total) with these results (Quint et al, 1985;Becker et al, 1986;Watt et al, 1989;Van Overhagen et al, 1993;Parmar et al, 2002).…”

The accuracy of endoscopic ultrasound for restaging esophageal carcinoma after chemoradiation therapy

“…EUS is superior to computed tomography (CT) for staging esophageal carcinoma with respect to locoregional disease. 1 EUS can improve the management of patients with esophageal carcinoma by offering a better definition of the tumor, which can lead to better clinical management and overall outcome. EUS has the ability to identify the intrawall layers of the esophagus, which have been shown to correspond histologically to the component layers of the esophageal wall.…”

“…2 Several series have reported an EUS accuracy Ͼ 85% for determining T classification and Ͼ 75% for determining N classification in patients who underwent surgical resection without neoadjuvant therapy. 1,3,4 Several authors have investigated the beneficial role of neoadjuvant chemoradiation therapy (CRT) in patients with potentially resectable esophageal adenocarcinoma to improve long-term survival. 5,6 Local preoperative staging of esophageal carcinoma with EUS is important in selecting better candidates for surgery and in determining which patients have potentially resectable disease.…”