Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus.
OBJECTIVE
Patients with esophageal high-grade dysplasia or mucosal esophageal cancer can be successfully treated by endoscopy. We performed a systematic review of the literature to determine whether endoscopic ultrasound (EUS) correctly predicts the T-stage of early esophageal cancers, compared with pathology specimens obtained by using endoscopic mucosal resection (EMR) or surgery.


METHODS
Standard systematic review methods were used to perform reference searches, determine eligibility, abstract data, and analyze data. When possible, individual patient-level data were abstracted, in addition to publication-level aggregate data.


RESULTS
Twelve studies had sufficient information to abstract and review for quality; 8 had individual patient-level data (n = 132). Compared with surgical or EMR pathology staging, EUS had T-stage concordance of 65%, including all studies (n = 12), but only 56% concordance when limited to individual patient-level data. Factors such as initial biopsy pathology (high-grade dysplasia vs early-stage cancer) did not appear to affect the concordance of staging between EUS and EMR/surgical staging.


CONCLUSIONS
EUS is not sufficiently accurate in determining the T-stage of high-grade dysplasias or superficial adenocarcinomas; other means of staging, such as EMR, should be used.
Young
Patrick E
PE
National Naval Medical Center, Bethesda, Maryland 20889, USA. patrick.young2@med.navy.mil
Gentry
Andrew B
AB
Acosta
Ruben D
RD
Greenwald
Bruce D
BD
Riddle
Mark
M
D000230:Adenocarcinoma / Q000175:diagnosis*; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000473:pathology*; D006651:Histocytochemistry; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index