OGC P47 The Role of Endoscopic Ultrasound Scan In Staging Patients With Oesophageal Cancer- A Retrospective Single Centre Study

Abstract

Background There are conflicting opinions on the role of Endoscopic Ultrasound (EUS) in the staging of oesophageal cancer (OG) patients which can complicate and delay intervention. We aim to audit the use of EUS in the OG cancer staging pathway as well as assess accuracy in selected cases. Methods A retrospective audit of the hospital database of patients diagnosed with oesophageal carcinoma between January 2016 and March 2021.The duration between the first MDT and EUS performed was calculated. Concordance between initial CT and EUS stage as well as histology in patients that were offered direct to surgery were evaluated using Cohen's Weighted Kappa. Results A total of 301 patients were identified. Overall, there was a moderate agreement (K=0.526) between CT and EUS reported T Staging(p<0.001). There was substantial agreement (K=0.798) between CT reporting T2, T3 and EUS(p<0.0005). Twenty-seven patients underwent upfront surgery-11 were T1, 16 were T2 and T3 disease. Comparing to final histology, EUS reported an accurate T1 stage in 36.3% compared with 0% with CT (p=0.018), whereas T2 and T3 disease were accurately reported with EUS and CT in 43.7% and 37.5% respectively (p=0.375). The median number of days between first MDT and EUS was 14 days (8,18) and this was requested after CT and PET CT results were available in 80% of cases. Conclusions This audit demonstrates minor differences between EUS and CT for T2 and T3 disease and therefore unlikely to alter management. However, EUS is superior to CT for staging Tx and T1 disease and is therefore likely to impact on the treatment options. EUS also contributed to prolonged pre-treatment staging time. Adopting a selective approach to EUS could result in overall reduction of waiting times from referral to decision making and increase cost-effectiveness.