title: Staging of adenocarcinoma of the gastroesophageal junction.
abstract: BACKGROUND
  Clinical staging of adenocarcinoma of the gastroesophageal junction (GEJ) determines the curative treatment regimen containing either neoadjuvant chemotherapy or chemoradiotherapy followed by either gastrectomy or esophagectomy. The value of current diagnostic tools is a matter of debate.
  
  
  METHODS
  A prospective database (2003-2013) was used to identify 266 consecutive patients with adenocarcinoma of the GEJ in order to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) regarding tumor localization according to Siewert, nodal status and its consequences on treatment strategy.
  
  
  RESULTS
  Overall accuracy in determining tumor localization was 73% for endoscopy/EUS and 61% for CT (p = 0.018). With endoscopy/EUS, the accuracy was 97%, 66% and 75% respectively for type I, II and III. With CT this was respectively 69%, 57% and 80%. The overall accuracy for determining N-status (N0/N+) per patient was 75% for EUS and 71% for CT. Accuracy for determining a positive nodal station in patients without neoadjuvant therapy was 77% for EUS and 71% for CT (p = 0.001). Accuracy for detecting positive upper mediastinal nodes was 80-92%, whereas for peritumoral and abdominal nodes this was 50-80% in both EUS and CT. In 8/266 patients (3%) the type of surgery changed due to intraoperative findings. A radical resection was performed in 233 patients (88%).
  
  
  CONCLUSIONS
  Despite the suboptimal accuracy of determining tumor localization with EUS and CT, in only a small number of patients an intraoperative change of surgical treatment was needed. EUS is superior to CT in determining nodal status and tumor localization in GEJ tumors.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: k.parry@umcutrecht.nl.
authors.forename: K
authors.initials: K
authors.lastname: Parry
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Haverkamp
authors.affiliation: Department of Radiology, University Medical Center Utrecht, The Netherlands.
authors.forename: R C G
authors.initials: RC
authors.lastname: Bruijnen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Pathology, University Medical Center Utrecht, The Netherlands.
authors.forename: G J A
authors.initials: GJ
authors.lastname: Offerhaus
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: R.vanHillegersberg@umcutrecht.nl.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009426:Netherlands; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Adenocarcinoma; Gastroesophageal junction; Lymph nodes; Tumor staging