title: Staging of esophageal cancer by EUS: staging accuracy revisited.
abstract: BACKGROUND
  EUS plays an important role in the preoperative staging of esophageal cancer. Recent data have called into question the staging accuracy of EUS, particularly in patients with early disease.
  
  
  OBJECTIVE
  Our goals were to assess our institution's EUS staging accuracy by experienced endosonographers in a contemporary cohort of patients encompassing a wide range of disease stages and to assess staging accuracy after dilation of malignant strictures.
  
  
  METHODS
  Retrospective data review.
  
  
  METHODS
  Single tertiary care center.
  
  
  METHODS
  A total of 42 patients with esophageal cancer undergoing preoperative EUS staging without neoadjuvant chemoradiotherapy between December 1999 and December 2004 were evaluated.
  
  
  METHODS
  EUS T and N stage sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
  
  
  RESULTS
  EUS accurately predicted T stage in 76% of cases and N stage in 89% of cases. Staging accuracy for T3 versus T1 and T2 disease and for N0 versus N1 disease was not significantly different. In 11 cases, malignant strictures required dilation, with 6 tumors being passable post dilation. Post dilation, T staging accuracy was 80% in impassable tumors and 100% in passable tumors, and N staging accuracy was 100% in the passable tumors.
  
  
  CONCLUSIONS
  Relatively small number of patients.
  
  
  CONCLUSIONS
  EUS accurately predicts T and N stage in patients with a range of disease stages. EUS provides good staging accuracy after dilation of malignant strictures regardless of whether full tumor traversal post dilation is possible.
authors.affiliation: Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Shimpi
authors.forename: Josh
authors.initials: J
authors.lastname: George
authors.forename: Paul
authors.initials: P
authors.lastname: Jowell
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity