title: Prognostic significance of failure to cross esophageal tumors by endoluminal ultrasound.
abstract: Failure to intubate and cross esophageal tumors by endosonography is reported in as many as 30% of cases and is thought to be associated with an especially poor prognosis. The aim of this study was to audit the above in a large consecutive case series of Endoscopic Ultrasound (EUS) examinations for esophageal cancer performed in a regional specialist cancer network with particular reference to outcome. A consecutive series of 411 patients underwent EUS examination by a specialist radiologist over a period of 9 years. Forty (10%) of patients required dilation, and there was total failure to cross the tumor in 12 patients (2.9%). Failure to traverse the primary tumor was associated with a diagnosis of squamous cell cancer (8 of 12 patients, 66%, rho = -0.182, P = 0.011). Limited staging information was obtained in 7 of these patients, which altered the computed tomography stage in 5 patients (71%, 3 upstaged, 2 downstaged). Six patients received definitive chemoradiotherapy, two patients surgery and four patients palliative chemotherapy. The median and 5-year survival in patients whose tumors were not crossed was 10 months and 28%, respectively, compared with 24 months and 24%, respectively in patients whose tumors were fully assessed. Failure to cross esophageal tumors in practice was far less common than the literature suggests, and esophageal tumor luminal stenosis should no longer be considered a limitation of endosonography.
authors.affiliation: South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Morgan
authors.forename: C P
authors.initials: CP
authors.lastname: Twine
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
authors.forename: R
authors.initials: R
authors.lastname: Lambe
authors.forename: H E
authors.initials: HE
authors.lastname: Oliphant
authors.forename: M
authors.initials: M
authors.lastname: Robinson
authors.forename: T D L
authors.initials: TD
authors.lastname: Crosby
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002404:Catheterization / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D011336:Probability; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D047368:Tumor Burden