Endoscopy 2019; 51(04): S18
DOI: 10.1055/s-0039-1681221
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: EUS diagnosis Club D
Georg Thieme Verlag KG Stuttgart · New York

STAGING ESOPHAGEAL AND JUNCTIONAL CANCER: IS EUS AN ACCURATE TOOL IN T2 N0 PATIENTS?

G de Nucci
1   Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese-Milano, Italy
,
MC Petrone
2   Bilio Pancreatic Endoscopy and Endoscopy Ultrasound Unit, San Raffaele Hospital, Milan, Italy
,
G Rossi
2   Bilio Pancreatic Endoscopy and Endoscopy Ultrasound Unit, San Raffaele Hospital, Milan, Italy
,
E Asti
3   General Surgery Unit II, San Donato Hospital, Milano, Italy
,
G Manes
1   Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese-Milano, Italy
,
L Bonavina
3   General Surgery Unit II, San Donato Hospital, Milano, Italy
,
PG Arcidiacono
2   Bilio Pancreatic Endoscopy and Endoscopy Ultrasound Unit, San Raffaele Hospital, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Esophageal cancer (EC) is one of the most lethal malignancies worldwide. Staging of EC is performed with computed tomography (CT), endoscopic ultrasonography (EUS) and (FDG) positron-emission tomography (PET). Patients can be managed in different ways, and this is influenced by the lymphnode (N)-stage of disease. Compared to surgical pathology, EUS has 85% accuracy in staging tumor depth and only about 75% accuracy in staging regional N metastases. Diagnosing clinical T2N0M0 cancers is the most challenging because an error in staging, changes the treatment. The aim of this study is to report a single high volume center's experience in this subset of patients combined with the experience of a high volume thoracic surgery center.

Methods:

259 patients, retrospective collected, underwent EUS for staging of EC between January 2010 and August 2018. 62 patients (49 men) received a diagnosis of cT2N0M0 disease by EUS with previous staging with Ct scan and PET confirming the absence of distant/nodal metastasis. All the patient underwent standard surgical resection without preoperative chemoradiation. The preoperative EUS staging (cTNM) was then compared to surgical pathology (pTNM) results to evaluate accurancy.

Results:

Comparing preoperative EUS stage of cT2N0 with surgical pathology, 35/62 (55%) were valutated correctly, 22 (35,5%) patients resulted understaged, 5 patients (9,5%) were overstaged. Among the understated patients, it's useful to distiguish between who was understaged by tumor depth (8 pts), by nodal involment (7 pts) or both (8 pts). The 5 overstaged patients had a T1b stage without nodal involment. EUS shows an accurancy of 77% in staging for tumor depth and of 84% in staging for nodal malignancy. The positive predictive value (PPV) of a cT2N0 EC was 56% (35 pT2N0/62 cT2N).

Conclusions:

Accuracy of eus staged T2N0M0 EC appears slightly sufficient, only the 56% of patients underwent appropriate therapy based on their pathological staging.