Preoperative TN staging of esophageal cancer: Comparison of miniprobe ultrasonography, spiral CT and MRI

Wu, Ling‐Fei; Wang, Bing-Zhou; Jia, Feng; Cheng, Wei-Rong; Liu, Guo-Re; Xu, Ximing; Zheng, Zhichao

doi:10.3748/wjg.v9.i2.219

Cited by 89 publications

(53 citation statements)

References 63 publications

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“…For T staging, there were 43 studies [10,18,[20][21][22][23][24] . There were 44 studies for nodal staging [10,18,[20][21][22][23][24][38][39][40][41][42][43][44][45][46][48][49][50]53,54,[56][57][58][59][60][61][62][63][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] , and of these, 4 used FNA for nodal staging [23,…”

Section: Resultsmentioning

confidence: 99%

“…With EUS emerging as a very useful staging tool, its role in staging esophageal cancer continues to be addressed. Several studies have identified the potential benefits of EUS with esophageal cancer staging; however, results regarding the extent of its benefits have been inconsistent [52,72,82] . We conducted a meta-analysis to examine the role of EUS in the staging of esophageal cancer for loco-regional spread.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Puli¹,

Jb²,

Ml³

et al. 2008

WJG

331

191

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AIM:To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS:Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS:Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ 2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION:EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Puli¹,

Jb²,

Ml³

et al. 2008

WJG

331

191

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“…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).…”

Section: Literature Search and Data Extractionmentioning

confidence: 99%

“…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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“…In the literature, CT and MRI both show low accuracy compared to EUS to determine T stage (45% and 60%, respectively). 10,11 Therefore, it was investigated in the present study whether performing bronchoscopy after EUS has any additional value. In this study, bronchoscopy did not detect any patients with airway invasion that was not already detected by EUS.…”

Section: Discussionmentioning

confidence: 99%

Value of Bronchoscopy after EUS in the Preoperative Assessment of Patients with Esophageal Cancer at or Above the Carina

Omloo

Heijl

Bergman

et al. 2008

Journal of Gastrointestinal Surgery

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Introduction Esophageal cancer is an aggressive disease with a strong tendency to infiltrate into surrounding structures. The aim of the present study is to determine the additional value of bronchoscopy for detecting invasion of the tracheobronchial tree after endoscopic ultrasonography (EUS) in the preoperative assessment of patients with esophageal cancer at or above the carina. Materials and Methods Between January 1997 and December 2006, 104 patients were analyzed for histologically proven esophageal cancer at or above the carina. All patients underwent both EUS and bronchoscopy (with biopsy on indication) in the preoperative assessment of local resectability. Results and Discussion After extensive diagnostic workup, 58 of 104 patients (56%) were eligible for potentially curative esophagectomy; nine of these 58 patients (9/58, 15%) appeared to be incurable peroperatively because of ingrowth in the tracheobronchial tree (five patients), ingrowth in other vital structures (two patients) or distant metastases (two patients). Of the 46 non-operable patients, local irresectability (T-stage 4) was identified in 26 patients (26/46, 57%) due to invasion of vital structures on EUS: invasion of the aorta in six patients, invasion of the lung in 11 patients; in 12 patients invasion of the tracheobronchial tree was described, which was confirmed by bronchoscopy in only five patients. No patients with T4 were identified by bronchoscopy alone. Conclusion For patients with esophageal tumors at or above the carina, no additional value of bronchoscopy (with biopsy on indication) to exclude invasion of the tracheobronchial tree was seen after EUS in a specialized centre. Although based on relatively small numbers, we conclude that bronchoscopy is not indicated if no invasion of the airways is identified on EUS.

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Preoperative TN staging of esophageal cancer: Comparison of miniprobe ultrasonography, spiral CT and MRI

Abstract: MPS is superior to spiral CT or MRI for T staging, especially in early esophageal cancer. However, the three modalities have the similar accuracy in N staging. Spiral CT or MRI is helpful for the detection of far-distance metastasis in esophageal cancer.

Cited by 89 publications

References 63 publications

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

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

Staging investigations for oesophageal cancer: a meta-analysis

Value of Bronchoscopy after EUS in the Preoperative Assessment of Patients with Esophageal Cancer at or Above the Carina

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