Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation?

Autor: Khaldoun Almhanna, Carrie Luu, Jessica M. Frakes, Jacques P. Fontaine, Cynthia L. Harris, Jose M. Pimiento, Sarah E. Hoffe, Marisa Amaral, Jason B. Klapman
Rok vydání: 2017
Předmět:
Male
Endoscopic ultrasound
Staging
Esophageal Neoplasms
medicine.medical_treatment
Esophageal cancer
Endoscopic mucosal resection
Endosonography
0302 clinical medicine
hemic and lymphatic diseases
skin and connective tissue diseases
Neoadjuvant therapy
Aged
80 and over
medicine.diagnostic_test
Gastroenterology
Chemoradiotherapy
General Medicine
Middle Aged
Early esophageal cancer
Neoadjuvant Therapy
medicine.anatomical_structure
Esophagectomy
Lymphatic Metastasis
030220 oncology & carcinogenesis
Adenocarcinoma
Female
030211 gastroenterology & hepatology
Esophagoscopy
Radiology
therapeutics
Adult
medicine.medical_specialty
Endoscopic Mucosal Resection
03 medical and health sciences
Esophagus
Retrospective Study
Preoperative Care
medicine
Humans
neoplasms
Aged
Neoplasm Staging
Retrospective Studies
business.industry
medicine.disease
digestive system diseases
stomatognathic diseases
Positron-Emission Tomography
Feasibility Studies
business
Zdroj: World Journal of Gastroenterology
ISSN: 1007-9327
Popis: AIM To evaluate the accuracy of endoscopic ultrasound (EUS) in early esophageal cancer (EC) performed in a high-volume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with cT1N0 and cT2N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student’s t test and Fisher’s exact test or χ2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy. RESULTS Between 2000 and 2015, 139 patients with clinical stageIorIIA esophageal cancer undergoing esophagectomy were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle third of the esophagus in 11 (8%) and lower third and gastroesophageal junction in 128 (92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. Positron emission tomography (PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients (6%) in whom both EUS and PET were negative for nodal involvement. CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.
Databáze: OpenAIRE
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