7055 Management decision making in esophageal carcinoma: does use of eus obviate the need for ct scanning?

Autor: Gary C. Vitale, Leela Bhupalam, Gregory M. Woolfolk, D. N. Reed, Whitney Jones, Stephen A. McClave
Rok vydání: 2000
Předmět:
Zdroj: Gastrointestinal Endoscopy. 51:AB255
ISSN: 0016-5107
Popis: INTRO: Despite greater accuracy with EUS, CT scan is used as the initial staging modality by most physicians.We designed this study to determine whether use of EUS as the primary diagnostic test would change management strategy and impact the utility of information obtained by CT scan. METHODS: Patients with esophageal cancer referred for EUS with concurrent CT scan were studied. EUS TNM stage, determined prospectively, was compared retrospectively to CT scan. Decisions for chemoRx, XRT, and surgery for each stage were determined from our previous survey (Gastro Endo 1996;43:553) by majority of 71 physicians from 4 specialties. Impact of testing sequence was determined by alternating the order of the 2 tests, evaluating change in treatment based on the first test due to information obtained by the second test. Statistical analysis was done by Chi square test. RESULTS: 43 CT and EUS evaluations were done in 42 patients (mean age 61.3 yrs; 93% male) out of 63 referred for EUS. Overall TNM stage by EUS was higher than CT in 29 patients (due to greater T stage in 6, N stage in 10, both T+N stage in 13), lower in 6 patients (lower T stage in 2, missed M stage in 4). With variation between specialties, differences in staging between the 2 tests would not always lead to changes in management. Table below shows % of patients whose therapy determined by the first test would be changed by information from the second test. Performing EUS first would have resulted in significantly fewer changes in management following subsequent CT scan, than if the sequence of tests were reversed (p
Databáze: OpenAIRE
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