BACKGROUND: Accurate pretreatment staging is essential to decision making for patients with esophageal and junctional cancers, particularly when choosing endoscopic therapy or a multimodal approach. As the efficacy of endoscopic ultrasonography (EUS) has been reported as variable, we assessed it prospectively in a large cohort from a high-volume center. METHODS: The EUS data from 2007 to 2011 were reviewed and analyzed. We conducted a comparative analysis with computed tomography-positron emission tomography (CT-PET) staging and pathology. Survival was analyzed by Kaplan-Meier testing on EUS-predicted T- and N-stage cohorts. RESULTS: Altogether, 222 patients underwent EUS. Among patients undergoing primary surgical resection, preoperative EUS diagnosed the T stage correctly in 71 % (55/77) of cases. Sensitivity and specificity for T1, T2, and T3 tumors were 94 and 89 %, 55 and 80 %, and 66 and 93 %, respectively. Mean maximum standard uptake volume on CT-PET correlated moderately with the EUS T stage (r = 0.42, p < 0.0001). EUS accuracy for nodal disease was 65 %. Survival was statistically better for the EUS T1 group than for those with T3 tumors (p = 0.01). Nodal metastases diagnosed on EUS predicted a significantly worse prognosis than EUS-negative nodes on both univariate and multivariate analyses (p < 0.0001 and p = 0.005 respectively). CONCLUSIONS: There was a significant relation between EUS T and N stages and overall survival. EUS demonstrated 71 % accuracy for the overall T stage. Staging accuracy of EUS for large lesions was less effective than for T1 tumors, underlining the need for a multimodal investigative approach to stage esophageal tumors accurately.
BACKGROUND: Accurate pretreatment staging is essential to decision making for patients with esophageal and junctional cancers, particularly when choosing endoscopic therapy or a multimodal approach. As the efficacy of endoscopic ultrasonography (EUS) has been reported as variable, we assessed it prospectively in a large cohort from a high-volume center. METHODS: The EUS data from 2007 to 2011 were reviewed and analyzed. We conducted a comparative analysis with computed tomography-positron emission tomography (CT-PET) staging and pathology. Survival was analyzed by Kaplan-Meier testing on EUS-predicted T- and N-stage cohorts. RESULTS: Altogether, 222 patients underwent EUS. Among patients undergoing primary surgical resection, preoperative EUS diagnosed the T stage correctly in 71 % (55/77) of cases. Sensitivity and specificity for T1, T2, and T3 tumors were 94 and 89 %, 55 and 80 %, and 66 and 93 %, respectively. Mean maximum standard uptake volume on CT-PET correlated moderately with the EUS T stage (r = 0.42, p < 0.0001). EUS accuracy for nodal disease was 65 %. Survival was statistically better for the EUS T1 group than for those with T3 tumors (p = 0.01). Nodal metastases diagnosed on EUS predicted a significantly worse prognosis than EUS-negative nodes on both univariate and multivariate analyses (p < 0.0001 and p = 0.005 respectively). CONCLUSIONS: There was a significant relation between EUS T and N stages and overall survival. EUS demonstrated 71 % accuracy for the overall T stage. Staging accuracy of EUS for large lesions was less effective than for T1 tumors, underlining the need for a multimodal investigative approach to stage esophageal tumors accurately.
Authors: P Flamen; A Lerut; E Van Cutsem; W De Wever; M Peeters; S Stroobants; P Dupont; G Bormans; M Hiele; P De Leyn; D Van Raemdonck; W Coosemans; N Ectors; K Haustermans; L Mortelmans Journal: J Clin Oncol Date: 2000-09-15 Impact factor: 44.544
Authors: Gregory Zuccaro; Thomas W Rice; John J Vargo; John R Goldblum; Lisa A Rybicki; John A Dumot; David J Adelstein; Patricia A Trolli; Eugene H Blackstone Journal: Am J Gastroenterol Date: 2005-03 Impact factor: 10.864
Authors: John Vincent Reynolds; Cian Muldoon; Donal Hollywood; Narayanasamy Ravi; Suzanne Rowley; Ken O'Byrne; John Kennedy; Thomas J Murphy Journal: Ann Surg Date: 2007-05 Impact factor: 12.969
Authors: A Kutup; B-C Link; P G Schurr; T Strate; J T Kaifi; M Bubenheim; S Seewald; E F Yekebas; N Soehendra; J R Izbicki Journal: Endoscopy Date: 2007-08 Impact factor: 10.093
Authors: H L van Westreenen; M Westerterp; G W Sloof; H Groen; P M M Bossuyt; P L Jager; E F Comans; H M van Dullemen; P Fockens; J Stoker; E J van der Jagt; J J B van Lanschot; J T M Plukker Journal: Br J Surg Date: 2007-12 Impact factor: 6.939
Authors: Mark Radlinski; Linda W Martin; Dustin M Walters; Patrick Northup; Andrew Y Wang; Terri Rodee; Bryan G Sauer; Vanessa M Shami Journal: J Thorac Dis Date: 2020-10 Impact factor: 2.895
Authors: R Taylor Ripley; Inderpal S Sarkaria; Rachel Grosser; Camelia S Sima; Manjit S Bains; David R Jones; Prasad S Adusumilli; James Huang; David J Finley; Valerie W Rusch; Nabil P Rizk Journal: Ann Thorac Surg Date: 2015-10-23 Impact factor: 4.330
Authors: Carrie Luu; Marisa Amaral; Jason Klapman; Cynthia Harris; Khaldoun Almhanna; Sarah Hoffe; Jessica Frakes; Jose M Pimiento; Jacques P Fontaine Journal: World J Gastroenterol Date: 2017-12-14 Impact factor: 5.742