Staging accuracy of endoscopic ultrasonography in esophageal cancer, Jae Hoon Cheong, Pusan National University Hospital

Background and aim: Surgery is considered the treatment of choice for advanced esophageal cancers, but the 5-year survival rate in the resected group is still dismal. It is important to determine the depth of infiltration of the cancer into the esophageal wall and presence of lymph nodes or metastasis. Endoscopic ultrasonography (EUS) has been shown to provide accurate assessment of the depth of tumor invasion and regional lymph nodes. The purpose of this study was to analyze the staging accuracy of esophageal cancer by EUS.

Methods: All patients who received EUS for staging of esophageal cancer before resection was retrospectively enrolled from November 2005 to June 2009.

Results: 61 patients (mean age 63.2±7.8 years: 57 men, 4 women) underwent esophagectomy for squamous cell carcinoma. Postoperatively, 36 patients were staged as having T1 cancers (59%), 7 patients T2 (11.5%), 18 patients T3 (29.5%). the sensitivity and specificity of EUS relative to the T stage were 86% and 96% for T1; 57% and 78% for T2; and 61% and 95% for T3. The overall accuracy for EUS in identifying the correct T stage was 75.4%. The sensitivity, specificity and accuracy of EUS for N1 were 71%, 81% and 77%, respectively.

Conclusion: Endoscopic ultrasonography is a useful diagnostic modality in determining the initial stage of esophageal cancer. But, T3 tumors are frequently understaged, which may benefit from neoadjuvant therapy.