title: N-staging of oesophageal and junctional carcinoma: is there still a role for EUS in patients staged N0 at PET/CT?
abstract: OBJECTIVE
  To assess whether separate endoscopic ultrasound (EUS) lymph node (N)-staging is still of prognostic value in those staged node negative (N0) at combined positron-emission tomography/computed tomography (PET/CT) in patients with oesophageal cancer (OC).
  
  
  METHODS
  One hundred and seventeen consecutive patients [median age 67 years; 88 male; 98 cases of adenocarcinoma, 19 cases of squamous cell carcinoma (SCC)] staged as N0 at PET/CT underwent EUS to record tumour (T)- and N-stage. The patients were subsequently separated into two groups: EUS N0 (n = 78) and EUS N+ (n = 39). Survival analysis using Kaplan-Meier and Cox's proportional hazard methods was performed. Primary outcome was overall survival from diagnosis.
  
  
  RESULTS
  EUS N-stage and EUS N0 versus EUS N+ (p = 0.005 and p = 0.001, respectively) were found to be significantly and independently associated with survival in two models of multivariate analysis, in patients staged N0 at PET/CT. EUS T-stage was significantly associated with survival on univariate analysis.
  
  
  CONCLUSIONS
  EUS N-staging still has prognostic value in patients staged N0 at PET/CT. There is a significant difference in survival between EUS N0 and positive nodal EUS status in those staged N0 at PET/CT, suggesting PET/CT is unreliable for local staging. PET/CT and EUS continue to have complimentary roles in OC staging.
authors.affiliation: Department of Radiology, University Hospital of Wales, Cardiff, UK. Electronic address: kfoley@doctors.org.uk.
authors.forename: K G
authors.initials: KG
authors.lastname: Foley
authors.affiliation: Department of Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
authors.affiliation: Department of Wales Research & Diagnostic Positron Emission Tomography Imaging Centre (PETIC), University Hospital of Wales, Cardiff, UK.
authors.forename: P
authors.initials: P
authors.lastname: Fielding
authors.affiliation: Department of Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karran
authors.affiliation: Department of Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.affiliation: Department of Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: P
authors.initials: P
authors.lastname: Blake
authors.affiliation: Department of Radiology, University Hospital of Wales, Cardiff, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed