title: Endoscopic ultrasound in staging esophageal cancer after neoadjuvant chemotherapy--results of a multicenter cohort analysis.
abstract: BACKGROUND
  Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen's kappa statistics.
  
  
  RESULTS
  For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: -/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen's kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients.
  
  
  CONCLUSIONS
  EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.
authors.affiliation: Department of Medicine B, Münster University Hospital, Münster, Germany.
authors.forename: Hauke Sebastian
authors.initials: HS
authors.lastname: Heinzow
authors.forename: Hans
authors.initials: H
authors.lastname: Seifert
authors.forename: Sven
authors.initials: S
authors.lastname: Tsepetonidis
authors.forename: Heiner
authors.initials: H
authors.lastname: Wolters
authors.forename: Torsten
authors.initials: T
authors.lastname: Kucharzik
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Dirk
authors.initials: D
authors.lastname: Domagk
authors.forename: Tobias
authors.initials: T
authors.lastname: Meister
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
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