Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer

Background and study aim: Endoscopic ultrasound (EUS) has been regarded as the most accurate staging tool in esophageal cancer. Staging results have a strong impact on the decision as to whether a patient should undergo endoscopic treatment, surgery alone, or neoadjuvant therapy. This retrospective study was conducted to analyze the accuracy of esophageal cancer staging using EUS.

Methods: All patients who received EUS for staging of esophageal cancer before esophagectomy from February 2003 to December 2007 at a high volume academic tertiary care center were included.

Results: 179 consecutive patients (mean age 64.4 ± 9.5 years; 142 men) underwent esophageal resection for Barrett’s adenocarcinoma (n = 134) and squamous cell cancer (n = 45). Postoperatively, 99 patients were staged as having T1 cancers (55 %), 30 patients T2 (17 %), 46 patients T3 (26 %), and four patients T4 (2 %). The sensitivity and specificity of EUS relative to the T stage were 82 % and 91 %, respectively, for T1; 43 % and 85 % for T2; and 83 % and 86 % for T3. The overall accuracy for EUS in identifying the correct T stage was 74 % (95 %CI 66 – 80). Positive lymph nodes were diagnosed histologically in 68 patients (38 %). The sensitivity, specificity and accuracy of EUS for the diagnosis of N1 were 71 %, 74 % and 73 % (95 %CI 65 – 79), respectively.

Conclusions: The diagnostic accuracy of EUS in patients with esophageal cancer is still unsatisfactory. T2 cancers in particular are frequently overstaged, with a significant effect on the subsequent treatment strategy.

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