High-frequency probe ultrasonography has limited accuracy for detecting invasive adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma: a case series.
OBJECTIVE
To evaluate prospectively the accuracy of preoperative high-frequency (20 MHz) probe ultrasonography (HFPUS) for detecting invasive cancer in patients referred for esophagectomy because of an endoscopic biopsy diagnosis of high-grade dysplasia (HGD) or intramucosal carcinoma (ICA) in Barrett's esophagus (BE).


METHODS
Nine consecutive male patients (median age of 69 yr) who were referred for esophagectomy for HGD or ICA in BE agreed to participate. We performed conventional upper gastrointestinal endoscopy followed by HFPUS using a through-the-scope ultrasound probe (20 MHz), and we compared our preoperative findings with the pathologist's findings in the resected esophageal specimens.


RESULTS
There was complete agreement between the postoperative pathological findings and the preoperative HFPUS findings in only 4 of the 9 patients. HFPUS resulted in two false-negative diagnoses of esophageal cancer (both had T1 lesions in the resected specimens), one false-positive diagnosis of esophageal cancer, and two errors in tumor staging (1 understaged, 1 overstaged).


CONCLUSIONS
HFPUS has limited accuracy for identifying invasive cancer in patients found to have HGD or IMC in BE. Pending further refinements in technology, clinical management decisions in such patients should not be based solely on the results of HFPUS.
Waxman
Irving
I
University Chicago Section of Endoscopy and Therapeutics and the Cancer Research Center, Chicago, Illinois 60637, USA.
Raju
Gottumukkala S
GS
Critchlow
Jonathan
J
Antonioli
Donald A
DA
Spechler
Stuart Jon
SJ
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology; D001706:Biopsy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D016629:Esophagectomy; D004945:Esophagoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged