[Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus].
OBJECTIVE
Endoscopic ultrasound (EUS) is an important diagnostic tool for determining the best therapeutic strategy (primary resection, neoadjuvant therapy or palliation only) to offer esophageal or gastric cancer patients.


METHODS
In the present study (1992-2001),we evaluated the accuracy of EUS in adenocarcinomas of the distal esophagus and stomach and compared our results with pathologists findings as the gold standard.


RESULTS
Of the 222 patients studied, the precise examination of 11% EUS was not completely possible due to severe tumor stenosis. The accuracy of EUS with respect to T, N+/- and TN+/- amounted to 51%, 65% and 34% in 131 patients with adenocarcinomas of the esophageal gastric junction and to 50%, 66% and 37% in 91 patients with adenocarcinomas located in the fundus, corpus or antrum of the stomach respectively. With respect to T-stage, the overstaging of tumors was more common than understaging, especially in pT2b-carcinomas. The subgroup analysis of the 131 EGJ adenocarcinoma patients showed that the results obtained by EUS were slightly better in type I (distal esophageal cancer) than in type II and III cardia carcinomas (proximal gastric cancer).When comparing two observation periods (1992-1996 and 1997-2001), the accuracy of endoscopic ultrasound staging was very similar in both periods for T-category (51% vs 49%) and N-category (63% vs 64%) as well as for combined TN-staging (36% vs 35%) respectively.


CONCLUSIONS
In clinical routine examinations of adenocarcinomas of the stomach and the distal esophagus, the accuracy of EUS is not as good as the excellent results in the past--mostly obtained under study conditions--may suggest.
Bösing
N
N
Klinik für Allgemein- und Unfallchirurgie, Klinikum der Heinrich-Heine-Universität, Düsseldorf.
Schumacher
B
B
Frieling
T
T
Ohmann
C
C
Jungblut
R
R
Lübke
H
H
Böhner
H
H
Verreet
P
P
Röher
H-D
HD
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D003937:Diagnosis, Differential; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000473:pathology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005748:Gastric Fundus / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011706:Pyloric Antrum / Q000000981:diagnostic imaging / Q000473:pathology; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery