title: Appraisal of staging endoscopic ultrasonography in a modern high-volume esophageal program.
abstract: BACKGROUND
  Accurate pretreatment staging is essential to decision making for patients with esophageal and junctional cancers, particularly when choosing endoscopic therapy or a multimodal approach. As the efficacy of endoscopic ultrasonography (EUS) has been reported as variable, we assessed it prospectively in a large cohort from a high-volume center.
  
  
  METHODS
  The EUS data from 2007 to 2011 were reviewed and analyzed. We conducted a comparative analysis with computed tomography-positron emission tomography (CT-PET) staging and pathology. Survival was analyzed by Kaplan-Meier testing on EUS-predicted T- and N-stage cohorts.
  
  
  RESULTS
  Altogether, 222 patients underwent EUS. Among patients undergoing primary surgical resection, preoperative EUS diagnosed the T stage correctly in 71 % (55/77) of cases. Sensitivity and specificity for T1, T2, and T3 tumors were 94 and 89 %, 55 and 80 %, and 66 and 93 %, respectively. Mean maximum standard uptake volume on CT-PET correlated moderately with the EUS T stage (r = 0.42, p < 0.0001). EUS accuracy for nodal disease was 65 %. Survival was statistically better for the EUS T1 group than for those with T3 tumors (p = 0.01). Nodal metastases diagnosed on EUS predicted a significantly worse prognosis than EUS-negative nodes on both univariate and multivariate analyses (p < 0.0001 and p = 0.005 respectively).
  
  
  CONCLUSIONS
  There was a significant relation between EUS T and N stages and overall survival. EUS demonstrated 71 % accuracy for the overall T stage. Staging accuracy of EUS for large lesions was less effective than for T1 tumors, underlining the need for a multimodal investigative approach to stage esophageal tumors accurately.
authors.affiliation: Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland. naoimhof@gmail.com
authors.forename: Naoimh J
authors.initials: NJ
authors.lastname: O'Farrell
authors.forename: Vinod
authors.initials: V
authors.lastname: Malik
authors.forename: Claire L
authors.initials: CL
authors.lastname: Donohoe
authors.forename: Ciaran
authors.initials: C
authors.lastname: Johnston
authors.forename: Cian
authors.initials: C
authors.lastname: Muldoon
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome