Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy.
BACKGROUND
In past years multimodal neoadjuvant treatment for carcinoma of the esophagus has been used with increased frequency. Staging of the neoplasm still remains fundamental in evaluating the response to therapy and in planning operation. The aim of the present study was to assess the accuracy of endoscopic ultrasonography (EUS) in a group of patients with squamous cell carcinoma of the thoracic esophagus after undergoing radiotherapy and chemotherapy.


METHODS
Among a group of 111 patients with squamous cell carcinoma of the thoracic esophagus and treated with preoperative radiotherapy and chemotherapy, 87 were operated. In these patients it was possible to compare the results of EUS, with regard to depth of invasion of esophageal wall (T) and lymph node involvement (N), with the results of operation and histopathologic study.


RESULTS
Feasibility of EUS before and after neoadjuvant treatment was 71.2% and 83.9%, respectively. The overall accuracy of EUS regarding the wall invasion was 47.9%. The more frequent error was overstaging, especially in patients with complete response and in patients with minimal residual disease. In the assessment of lymph node involvement, EUS showed an overall accuracy of 71.2% with a moderate kappa value. Sensitivity for N1 and NO was 73.7% and 68.6%, respectively.


CONCLUSIONS
Endoscopic ultrasonography was feasible in most patients after preoperative radiotherapy and chemotherapy, but our study documented a worsening of accuracy of EUS in the evaluation of T attributable to the confounding presence of radiation fibrosis and soft tissue reaction after radiotherapy and chemotherapy.
Laterza
E
E
First Division of General Surgery, University of Verona, Italy.
de Manzoni
G
G
Guglielmi
A
A
Rodella
L
L
Tedesco
P
P
Cordiano
C
C
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012680:Sensitivity and Specificity