title: Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction.
abstract: BACKGROUND
  In esophageal cancer patients preoperative staging will determine the type of surgical procedure and use of neoadjuvant therapy. Tumor location and lymph node status play a pivotal role in this tailored strategy. The aim of the present study was to prospectively evaluate the accuracy of preoperative assessment of tumor location according to the Siewert classification and lymph node status per station with endoscopy/endoscopic ultrasound (EUS) and computed tomography (CT).
  
  
  METHODS
  In 50 esophagectomy patients with adenocarcinoma of the gastroesophageal junction (GEJ), tumor location according to Siewert and N-stage per nodal station as determined preoperatively by endoscopy/EUS and CT were compared with the histopathologic findings in the resection specimen.
  
  
  RESULTS
  Overall accuracy in predicting tumor location according to the Siewert classification was 70 % for endoscopy/EUS and 72 % for CT. Preoperative data could not be compared with the pathologic assessment in 11 patients (22 %), as large tumors obscured the landmark of the gastric folds. The overall accuracy for predicting the N-stage in 250 lymph node stations was 66 % for EUS and 68 % for CT. The accuracy was good for those stations located high in the thorax, but poor for celiac trunk nodes.
  
  
  CONCLUSIONS
  Given the frequent discrepancy between the endoscopic and pathologic location of the GEJ and the common problem of advanced tumors obscuring the landmarks used in the assessment of the Siewert classification, its usefulness is limited. The overall accuracy for EUS and CT in predicting the N-stage per station was moderate.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl
authors.forename: Brechtje A
authors.initials: BA
authors.lastname: Grotenhuis
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.forename: Jan Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: John J
authors.initials: JJ
authors.lastname: Hermans
authors.forename: Katharina
authors.initials: K
authors.lastname: Biermann
authors.forename: Manon C W
authors.initials: MC
authors.lastname: Spaander
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery