Staging accuracy of endoscopic ultrasound performed by nonexpert endosonographers in patients with resectable esophageal squamous cell carcinoma: is it possible?

Abstract

The accuracy of endoscopic ultrasound (EUS) is operator-dependent. According to learning curve study, the accuracy of EUS T-staging for esophageal cancer has been reported to be greater in an investigator who had performed at least 100 EUS examinations. We determined comparative study regarding T-staging accuracy of EUS for esophageal squamous cell carcinoma between expert and nonexpert endoscopic ultrasonographers. We retrospectively identified 73 consecutive patients with esophageal squamous cell carcinoma who underwent EUS and endoscopic mucosal resection, endoscopic submucosal dissection, or surgery. EUS was performed by expert (Group 1) and nonexpert (Group 2) endoscopic ultrasonographers in multitertiary hospitals. Groups 1 and 2 were 37 and 36 patients during 2005-2011, respectively. Forty-two patients (57.5%) of the overall patients underwent surgical exploration. Correct endoscopic ultrasonographic T-staging of Group 1 was observed in 34 (91.9%) patients, while that of Group 2 was observed in 26 (72.2%) patients. And there was significant difference in correct endoscopic ultrasonographic T-staging between Group 1 and Group 2 (P = 0.035). The incorrect endoscopic ultrasonographic T-staging of Group 1 were three cases that were overstaging (8.1%), but in Group 2 there were seven overstaging (19.4%) and three understaging (8.3%). There was no significant difference in overstaging or understaging of incorrect endoscopic ultrasonographic T-staging between Group 1 and Group 2 (P = 0.528). This study first provides evidence that endoscopic ultrasonographic T-staging of nonexpert endoscopic ultrasonographers was inferior to be correct, compared with that of expert endoscopic ultrasonographers. EUS staging for esophageal cancer should be performed by expert endoscopic ultrasonographers to provide appropriate management strategy.

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

“…1 Thus, the depth of invasion of SESCC must be accurately determined using endoscopy, endoscopic ultrasound, and magnifying endoscopy with narrow band imaging (NBI) before performing endoscopic resection of SESCC. [24][25][26][27][28] However, the evaluation of invasion depth is not perfectly accurate. Therefore, it is advisable to perform endoscopic resection instead of esophagectomy to avoid unnecessary operations when there is no obvious submucosal invasion because esophagectomy has high morbidities and mortalities.…”

Significance of baseline FDG-PET/CT scan as a method of staging regional lymph nodes in patients with operable distal oesophageal or gastroesophageal junction adenocarcinoma

“…EUS is recognised to be the optimal method to assess the size and number of affected lymph nodes, especially in PET-negative tumours [16]. However, EUS is highly operator-dependent, limiting its ability to provide consistent information [17]. In addition, not all patients are able to undergo EUS, because of bulky or stricturing tumours blocking the passage of the endoscope.…”

Clinical practice guideline for endoscopic resection of early gastrointestinal cancer

“…1 Thus, the depth of invasion of SESCC must be accurately determined using endoscopy, endoscopic ultrasound, and magnifying endoscopy with narrow band imaging (NBI) before performing endoscopic resection of SESCC. [24][25][26][27][28] However, the evaluation of invasion depth is not perfectly accurate. Therefore, it is ad- Statement C2: Endoscopic resection of submucosal colorectal cancer with a high risk of lymph node metastasis has a higher recurrence rate than surgical resection.…”