Staging of esophageal cancer by EUS: staging accuracy revisited.
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.
Shimpi
Rahul A
RA
Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina 27710, USA.
George
Josh
J
Jowell
Paul
P
Gress
Frank G
FG
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