Influence of Tumor Characteristics on the Accuracy of Endoscopic Ultrasonography in Staging Cancer of the Esophagus and Esophagogastric Junction

Background and Study Aims: Endoscopic ultrasonography (EUS) is the most accurate method of assessing the locoregional extent of cancer of the esophagus and esophagogastric junction. The aim of this study was to evaluate the influence of tumor-related factors such as length and location on the accuracy of EUS in staging these tumors.
Patients and Methods: Between January 1997 and September 2002, 280 consecutive patients underwent preoperative EUS for staging cancer of the esophagus and esophagogastric junction. The influence of histopathology, the presence of Barrett’s dysplasia or stenosis, and the location and length of the primary tumor on the accuracy of EUS for T, N, and M staging were studied.
Results: The overall accuracy rates of EUS for assessing the T, N, and M stages were 73 %, 80 %, and 78 %, respectively. The influence of the tumor’s histopathology and the presence of Barrett’s dysplasia or stenosis was minimal. The accuracy of EUS was greater in tumors 5 cm or less in size than in tumors larger than 5 cm (82 % vs. 52 % for the T stage, P < 0.05; 88 % vs. 59 % for the N stage, P < 0.05; and 92 % vs. 56 % for the M stage, P < 0.001). The low accuracy of T staging in larger tumors may be due to the exclusion of patients with local unresectability or distant metastases. EUS was also significantly better in esophageal tumors, particularly for identifying celiac trunk metastases (93 % vs. 63 %; P < 0.001).
Conclusions: The accuracy of EUS for staging esophageal cancer is lower in tumors larger than 5 cm and in esophagogastric junction tumors than in tumors 5 cm in size or less and in esophageal tumors. These findings should be considered when treatment decisions are being taken.

• 1 Allescher H D, Rösch T, Willkomm G. et al . Performance, patient acceptance, appropriateness of indications and potential influence on outcome of EUS: a prospective study in 397 consecutive patients.  Gastrointest Endosc. 1999;  50 737-745
• 2 Nickl N J, Bhutani M S, Catalano M. et al . Clinical implications of endoscopic ultrasound: the American Endosonography Club Study.  Gastrointest Endosc. 1996;  44 371-377
• 3 Rösch T. Endosonographic staging of esophageal cancer: a review of literature results.  Gastrointest Endosc Clin N Am. 1995;  5 537-547
• 4 Tio T L, Tytgat G N. Endoscopic ultrasonography in analysing peri-intestinal lymph node abnormality: preliminary results of studies in vitro and in vivo.  Scand J Gastroenterol Suppl. 1986;  123 158-163
• 5 Tio T L, Coene P P, Schouwink M H. et al . Esophagogastric carcinoma: preoperative TNM classification with endosonography.  Radiology. 1989;  173 411-417
• 6 Kelly S, Harris K M, Berry E. et al . A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma.  Gut. 2001;  49 534-539
• 7 Vazquez-Sequeiros E, Wiersema M J, Clain J E. et al . Impact of lymph node staging on therapy of esophageal carcinoma.  Gastroenterology. 2003;  125 1626-1635
• 8 Vilgrain V, Mompoint D, Palazzo L. et al . Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT.  AJR Am J Roentgenol. 1990;  155 277-281
• 9 Ziegler K, Sanft C, Zeitz M. et al . Evaluation of endosonography in TN staging of oesophageal cancer.  Gut. 1991;  32 16-20
• 10 Catalano M F, Alcocer E, Chak A. et al . Evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma: accuracy of EUS.  Gastrointest Endosc. 1999;  50 352-356
• 11 Reed C E, Mishra G, Sahai A V. et al . Esophageal cancer staging: improved accuracy by endoscopic ultrasound of celiac lymph nodes.  Ann Thorac Surg. 1999;  67 319-321
• 12 Devesa S S, Blot W J, Fraumeni J F Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.  Cancer. 1998;  83 2049-2053
• 13 Meining A, Dittler H J, Wolf A. et al . You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging.  Gut. 2002;  50 599-603
• 14 Eloubeidi M A, Desmond R, Arguedas M R. et al . Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status.  Cancer. 2002;  95 1434-1443
• 15 Sobin L H, Wittekind C. TNM classification of malignant tumours. 6th ed. New York; Wiley 2003
• 16 Nakamura T, Ide H, Eguchi R. et al . Adenocarcinoma of the esophagogastric junction: a summary of responses to a questionnaire on adenocarcinoma of the esophagus and the esophagogastric junction in Japan.  Dis Esophagus. 2002;  15 219-225
• 17 Siewert J R, Stein H J, Feith M. et al . Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world.  Ann Surg. 2001;  234 360-367
• 18 Blot W J, McLaughlin J K. The changing epidemiology of esophageal cancer.  Semin Oncol. 1999;  26 2-8
• 19 Fockens P, Van den Brande J H, van Dullemen H M. et al . Endosonographic T-staging of esophageal carcinoma: a learning curve.  Gastrointest Endosc. 1996;  44 58-62