Prospective comparison of optic versus blind endoscopic ultrasound in staging esophageal cancer

Twine, Christopher P.; Lewis, Wyn G.; Escofet, Xavier; Bosanquet, David C.; Roberts, S. A.

doi:10.1007/s00464-009-0491-6

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…The primary esophageal tumor was assessed, together with an evaluation of the para‐esophageal anatomical structures as described previously 7 . Malignant lymphadenopathy was defined by the following criteria: hypo echoic pattern, spherical contour, the presence of a distinct border, and a short axis diameter of 6 mm or more as previously described 8,9 . Individual nodes were counted during the initial examination.…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of the endoscopic ultrasound defined lymph node metastasis count in esophageal cancer

Twine

Roberts

Rawlinson

et al. 2010

Diseases of the Esophagus

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The key prognostic factor which predicts outcome after esophagectomy for cancer is the number of malignant lymph node metastases, but data regarding the accuracy of endoscopic ultrasound (EUS) in determining and predicting the metastatic lymph node count preoperatively are limited. The aim of this study was to assess the prognostic significance of EUS defined lymph node metastasis count (eLNMC) in patients diagnosed with esophageal cancer. Two hundred and sixty-seven consecutive patients (median age 63 years, 187 months) underwent specialist EUS followed by stage directed multidisciplinary treatment (183 esophagectomy [64 neoadjuvant chemotherapy, 19 neoadjuvant chemoradiotherapy], 79 definitive chemoradiotherapy, and 5 palliative therapy). The eLNMC was subdivided into four groups (0, 1, 2 to 4, >4) and the primary measure of outcome was survival. Survival was related to EUS tumor (T) stage (P < 0.0001), EUS node (N) stage (P < 0.0001), EUS tumor length (p < 0.0001), and eLNMC (P < 0.0001). Multivariable analysis revealed EUS tumor length (hazard ratio [HR] 1.071, 95% CI 1.008-1.138, P= 0.027) and eLNMC (HR 1.302, 95% CI 1.133-1.496, P= 0.0001) to be significantly and independently associated with survival. Median and 2-year survival for patients with 0, 1, 2-4, and >4 lymph node metastases were: 44 months and 71%, 36 months and 59%, 24 months and 50%, and 17 months and 32%, respectively. The total number of EUS defined lymph node metastases was an important and significant prognostic indicator.

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Section: Methodsmentioning

confidence: 99%

Prognostic significance of the endoscopic ultrasound defined lymph node metastasis count in esophageal cancer

Twine

Roberts

Rawlinson

et al. 2010

Diseases of the Esophagus

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“…Suspected lymphadenopathy was defined by the following criteria: hypoechoic pattern, spherical contour, presence of a distinct border, and short-axis diameter of 6 mm or greater. 6 Patients with lesions that extended to the cardia of the stomach or who received preoperative chemotherapy or radiotherapy also were excluded. In the remaining 107 patients, preoperative endoscopic examinations, pathology reports, operative intervention, cancer staging, and perioperative esophagectomy outcomes were reviewed.…”

Section: Methodsmentioning

confidence: 99%

“…The cN1 nodes met the following sonographic criteria: size greater than 1 cm, hypoechoic, distinct margins, and round shape. 6 In general, cT or cN denotes clinical stage determined by EUS, and pT or pN denotes pathologic stage determined by histopathology.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies

Bergeron

Lin

Chang

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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The sensitivity and specificity of endoscopic ultrasound for determining true pathologic staging are poor for early-stage esophageal cancers. Lesions thought to be cT1a-lpN0 by endoscopic ultrasound have at least pN1 disease in 15% of cases. Endoluminal therapy of these lesions based on endoscopic ultrasound undertreats a significant number of patients. Esophagectomy is still the standard therapy for early-stage esophageal cancers in the majority of patients.

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Radiological prediction of positive circumferential resection margin in oesophageal cancer

Foley

Christian

Patel

et al. 2018

European Journal of Radiology

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A positive circumferential resection margin (CRM) is regarded as a poor prognostic indicator in oesophageal cancer (OC) but its prediction can be challenging. MRI is used to predict a threatened CRM in rectal cancer but is not commonly performed in OC unlike PET/CT, which is now routinely used. Therefore, this study assessed the additional predictive value of PET-defined tumour variables compared with EUS and CT T-stage. The prognostic significance of CRM status was also assessed. Materials and Methods This retrospective study included 117 consecutive patients [median age 64.0 (range 24-78), 102 males, 110 adenocarcinomas, 6 squamous cell carcinoma (SCC), 1 neuro-endocrine] treated between 1 st March 2012 and 31 st July 2015. A binary logistic regression model tested 5 staging variables; EUS T-stage (T2 vs T3), CT T-stage (T2 vs T3), PET metabolic tumour length (MTL), PET metabolic tumour width (MTW) and the maximum standardised uptake value (SUVmax). Results The CRM was positive in 43.6%. Sixty-seven (57.3%) patients received neoadjuvant chemotherapy (NACT), 31 patients (26.5%) underwent surgery alone and 19 patients (16.2%) had neo-adjuvant chemo-radiotherapy (NACRT). Median overall survival (OS) was 36.0 months (95% confidence interval (CI) 24.1-47.9) and the 2-year OS was 55.4%. A binary logistic regression model showed EUS ≥T3 tumours were independently and significantly more likely to have a positive CRM than EUS ≤T2 tumours (HR 5.188, 95% CI 1.265-21.273, p=0.022). CT T-stage, PET MTL, PET MTW and SUVmax were not significantly associated with CRM status (p=0.783, 0.852, 0.605 and 0.413, respectively). There was a significant difference in OS between CRM positive and negative groups (X 2 4.920, df 1, p=0.027). Conclusion Advanced EUS T-stage is associated with a positive CRM, but PET-defined tumour variables are unlikely to provide additional predictive information. This study demonstrates the continued benefit of EUS as part of a multi-modality OC staging pathway.

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Prospective comparison of optic versus blind endoscopic ultrasound in staging esophageal cancer

Abstract: Blind probe EUS facilitated complete radiological staging in 31% of cases that would otherwise have resulted in a designation of failure to cross at EUS, and was as accurate as optic probe EUS in assessing pTN stage.

Cited by 3 publications

References 34 publications

Prognostic significance of the endoscopic ultrasound defined lymph node metastasis count in esophageal cancer

Prognostic significance of the endoscopic ultrasound defined lymph node metastasis count in esophageal cancer

Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies

Radiological prediction of positive circumferential resection margin in oesophageal cancer

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