The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography

Pfau, Patrick R.; Perlman, Scott; Stanko, Peter; Frick, Terrence J.; Gopal, Deepak V.; Said, Adnan; Zhang, Zhengjun; Weigel, Tracey L.

doi:10.1016/j.gie.2006.12.015

Cited by 100 publications

(61 citation statements)

References 31 publications

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“…It utilises an echo-endoscope which is able to visualise the individual histological layers of the oesophagus. The number of lymph nodes detected by this method correlates significantly with 5-year survival rates [24] and EUS detects more locoregional node involvement than CT or PET [25][26][27]. Preoperative M A N U S C R I P T…”

Section: Endoscopic Ultrasound (Eus)mentioning

confidence: 95%

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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Oesophageal cancer is the seventh most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The seventh edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.

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Section: Endoscopic Ultrasound (Eus)mentioning

confidence: 95%

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…This approach is particularly useful in evaluating invasion of local disease, especially esophageal cancer. EUS has been shown to detect more locoregional node involvement than CT or PET, with a higher sensitivity [17,18] . The accuracy of EUS to determine tumor depth has also been estimated to be quite accurate [18][19][20] .…”

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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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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“…T3 and T4. In addition, several studies have shown that EUS is even superior to CT and positron emission tomography (PET) to perform an appropriate T staging [16,17,18,19]. …”

Section: Discussionmentioning

confidence: 99%

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

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Background: Multimodality treatment options in locally advanced adenocarcinomas of the esophagogastric junction (AEGs) have been established in the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains controversial. The most important determinant is the accuracy of clinical staging. We aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences. Patients and Methods: Between 2001 and 2011, 71 patients with AEG tumors were clinically staged as cT2 (cN0 = 48 (68%); cN+ = 23 (32%)) and underwent surgical resection. Results: A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients received neoadjuvant therapy. Primarily resected patients showed the following pT/pN categories: pT1: 13 (22%), pT2: 35 (59%), pT3: 11 (19%), pN0: 23 (39%), whereas the clinical/histopathological pN category included 55% of the patients. Neoadjuvantly treated patients showed the following pT/pN categories: ypT0: 3 (25%), ypT1: 3 (25%), ypT2: 6 (50%), ypN0: 6 (50%). The overall survival of primarily resected patients compared with patients undergoing neoadjuvant therapy was not significantly different. Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primarily resected patients, over- and understaging balance each other; correct pretherapeutic staging occurs in just about 60% of the patients. Moreover, our study suggests that a radical surgical resection with adequate lymphadenectomy seems to be appropriate for cT2N0 and even in cT2N+ tumors, since down-categorizing and prognosis are not improved for neoadjuvantly treated patients. However, the data have to be interpreted with caution because of the small patient numbers.

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The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography

Cited by 100 publications

References 31 publications

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

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

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

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