title: Preoperative noninvasive EUS evaluation in patients with esophageal cancer considered for esophagectomy.
abstract: BACKGROUND
  Worldwide, esophageal cancer ranks fifth in the mortality rate regarding tumor locations. EUS is an essential tool in the evaluation of these patients allowing accurate staging and permitting stratified treatment options. AIM. We have studied prospectively the impact of EUS in the evaluation and decision for therapy of patients with esophageal cancer diagnosed in our center.
  
  
  METHODS
  From March 2001 through March 2006, 220 patients were hospitalized at the Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, with the diagnosis of esophageal cancer. Out of the 220 patients, 41 patients, with no major comorbidities contraindicating esophagectomy already having been screened by abdominal and thoracic CT to disclose distant metastases, had EUS with the definite purpose of staging esophageal carcinoma and selecting adequate therapy. Assuming that without preoperative staging by EUS, all 41 patients in the study group would have been offered surgical treatment, we evaluated the number of patients and the modality in which EUS resulted in changes to the therapeutic plan.
  
  
  RESULTS
  Depth of invasion was recorded for the 41 patients as follows: T1 in 2 patients (4.9%), T2 in 6 patients (14.6%), T3 in 24 patients (58.5%), and T4 in 10 patients (22%). Regional lymph node (N) status as determined by EUS criteria was as follows: N0 in 7 patients (17%) and N1 in 34 patients (83%). Assessment of distant metastases (M) was recorded showing 4 patients with celiac axis lymph nodes metastases (M1). Preoperative EUS staging changed the decision for surgery in 18 of 41 patients (44%) (p<0.0001) and allowed primary esophagectomy in only 6 patients (15%) (p<0.0001). Compared to histopathology, the overall accuracy of EUS staging for pT1 and pT2 was 80% for staging pT3 and pT4 77% and for lymph node evaluation was approximately 75%.
  
  
  CONCLUSIONS
  Esophageal EUS offers useful information to clinicians caring for patients with esophageal cancer, impacts clinical decision making, and should be used in appropriate settings to plan patients' care.
authors.affiliation: Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 72437 Bucharest, Romania. drgheorghe@xnet.ro
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Codrut
authors.initials: C
authors.lastname: Stanescu
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.forename: Ion
authors.initials: I
authors.lastname: Bancila
authors.forename: Vlad
authors.initials: V
authors.lastname: Herlea
authors.forename: Gabriel
authors.initials: G
authors.lastname: Becheanu
authors.forename: Daniela
authors.initials: D
authors.lastname: Voinea
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.forename: Ioana
authors.initials: I
authors.lastname: Lupescu
authors.forename: Rodica
authors.initials: R
authors.lastname: Anghel
authors.forename: Adina
authors.initials: A
authors.lastname: Croitoru
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D014463:Ultrasonography