title: Pretreatment Dysphagia in Esophageal Cancer Patients May Eliminate the Need for Staging by Endoscopic Ultrasonography.
abstract: BACKGROUND
  Neoadjuvant therapy is commonly administered to patients with localized disease who have T3-4 esophageal disease as staged by endoscopic ultrasound (EUS). Previously, we noted that patients who present with dysphagia have a higher EUS T stage. We hypothesized that the presence of dysphagia is predictive of EUS T3-4 disease and that staging EUS could be forgone for esophageal cancer patients with dysphagia.
  
  
  METHODS
  We performed a prospective, intent-to-treat, single-cohort study in which patients with potentially resectable esophageal cancer completed a standardized four-tier dysphagia score survey. EUS was performed as part of our standard evaluation. To determine whether the presence of dysphagia predicted EUS T3-4 disease, the dysphagia score was compared with EUS T stage.
  
  
  RESULTS
  The study enrolled 114 consecutive patients between August 2012 and February 2014: 77% (88 of 114) received neoadjuvant therapy, 18% (20 of 114) did not, and 5% (6 of 114) pursued treatment elsewhere. In total, 70% (80 of 114) underwent esophagectomy; of these, 54% (61 of 114) had dysphagia and 46% (53 of 114) did not. Dysphagia scores were 66% (40 of 61) grade 1, 25% (15 of 61) grade 2, and 10% (6 of 61) grade 3 to 4. Among patients with dysphagia, 89% (54 of 61) had T3-4 disease by EUS; among those without dysphagia, only 53% (28 of 53) had T3-4 disease by EUS (p < 0.001).
  
  
  CONCLUSIONS
  The presence of dysphagia in patients with esophageal cancer was highly predictive of T3-4 disease by EUS. On the basis of this finding, approximately 50% of patients currently undergoing staging EUS at our institution could potentially forgo EUS before neoadjuvant therapy. Patients without dysphagia, however, should still undergo EUS.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Inderpal S
authors.initials: IS
authors.lastname: Sarkaria
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grosser
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Camelia S
authors.initials: CS
authors.lastname: Sima
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Finley
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
mesh_terms: D055154:Dysphonia / Q000209:etiology / Q000628:therapy*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D019564:Unnecessary Procedures