Endosonografie Ösophagus und Magen

Zusammenfassung

Die Endosonografie gilt als die exakteste Methode beim Staging von Ösophagus- und Magenkarzinomen. Die Endosonografie ermöglicht eine Differenzierung des T-Stadiums beim Ösophagus- und Magenkarzinom mit einer Genauigkeit zwischen 65 und 90 %. Bei der Einschätzung von Frühkarzinomen scheint die Minisondenendosonografie jedoch der makroskopischen Beurteilung durch einen erfahrenen Endoskopiker nicht überlegen zu sein. Ein weiteres, die Therapie entscheidendes Kriterium ist der Lymphknotenstatus. Hier zeigt die Endosonografie eine hohe Sensitivität, jedoch eine nicht zufriedenstellende Spezifität. Durch die Feinnadelpunktion suspekter Lymphknoten, die mit einer sehr niedrigen Komplikationsrate einhergeht, kann mittels zytologischer Beurteilung eine Steigerung der Spezifität erreicht werden. Aber auch neue Methoden, wie die kontrastmittelverstärkte Endosonografie oder die Elastografie, scheinen bei der Differenzierung suspekter Lymphknoten hilfreich zu sein.

Abstract

Endosonography is considered to be the most exact method for the staging of carcionomas of the oesophagus and stomach. It enables a differentiation of the T stages of carcinomas of the oesophagus and stomach with an accuracy of between 65 and 90 %. Endosonography with a mini-probe, however, does not appear to be superior to the macroscopic evaluation by an experienced endoscopist. A futher decisive criterion for therapy is the lymph node status. Here, endosonography exhibits a high sensitivity albeit with an unsatisfactory specificity. The specificity can be increased by the cytological evaluation of biopsy samples from the fine needle puncture of suspicious lymph nodes, a method with a very low complication rate. But new methods such as contrast medium-enhanced endosonography or elastography also appear to be useful for the differentiation of suspicious lymph nodes.

Schlüsselwörter

Magenkarzinom - Ösophaguskarzinom - Barrett-Ösophagus

Key words

stomach carcinomas - oesophageal carcinoma - Barrett’s oesophagus

Literatur

• 1 Ell C, May A, Pech O. et al . Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer).  Gastrointest Endosc. 2007;  65 3-10
• 2 Pech O, May A, Rabenstein T. et al . Endoscopic resection of early oesophageal cancer.  Gut. 2007;  56 1625-1634
• 3 Cunningham D, Allum W H, Stenning S P. et al . Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.  N Engl J Med. 2006;  355 (1) 11-20
• 4 Buskens C J, Westerterp M, Lagarde S M. et al . Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features.  Gastrointest Endosc. 2004;  60 703-710
• 5 Stein H J, Feith M, Bruecher B LDM. et al . Early esophageal squamous cell and adenocarcinoma: Pattern of lymphatic spread and prognostic factors for long term survival after surgical resection.  Ann Surg. 2005;  242 566-573
• 6 May A, Guenter E, Roth F. et al . Accuracy of staging in oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial.  Gut. 2004;  53 634-640
• 7 Pech O, May A, Günter E. et al . The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus.  Am J Gastroenterol. 2006;  101 2223-2229
• 8 Scotiniotis I A, Kochman M L, Lewis J D. et al . Accuracy of EUS in the evaluation of Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma.  Gastrointest Endosc. 2001;  54 (6) 689-696
• 9 Larghi A, Lightdale C J, Memeo L. et al . EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus.  Gastrointest Endosc. 2005;  62 (1) 16-23
• 10 Chemaly M, Scalone O, Durivage G. et al . Miniprobe EUS in the pretherapeutic assessment of early esophageal neoplasia.  Endoscopy. 2007 [Epub ahead of print]; 
• 11 Esaki M, Matsumoto T, Moriyama T. et al . Probe EUS for the diagnosis of invasion depth in superficial esophageal cancer: a comparison between a jelly-filled method and a water-filled balloon method.  Gastrointest Endosc. 2006;  63 (3) 389-395
• 12 Rampado S, Bocus P, Battaglia G. et al . Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus.  Ann Thorac Surg. 2008;  85 (1) 251-256
• 13 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 (4) 534-539
• 14 Bergman J JGHM. The endoscopic diagnosis and staging of oesophageal adenocarcinoma.  Best Pract Res Clin Gastroenterol. 2006;  20 (5) 843-866
• 15 Kutup A, Link B C, Schurr P G. et al . Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer.  Endoscopy. 2007;  39 (8) 715-719
• 16 Shimpi R A, George J, Jowell P. et al . Staging of esophageal cancer by EUS: staging accuracy revisited.  Gastrointest Endosc. 2007;  66 (3) 475-482
• 17 Pfau P R, Ginsberg G G, Lew R J. et al . Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective.  Am J Gastroenterol. 2000;  95 (10) 2813-2815
• 18 Jacobson B C, Shami V M, Faigel D O. et al . Through-the-scope balloon dilation for endoscopic ultrasound staging of stenosing esophageal cancer.  Dig Dis Sci. 2007;  52 (3) 817-822
• 19 Grimm H, Binmoeller K F, Soehendra N. Ultrasonic esophagoprobe (prototype I).  Gastrointest Endosc. 1992;  38 490-493
• 20 Vazquez-Sequeiros E, Wiersema M J, Clain J E. et al . Impact of lymph node staging on therapy of esophageal carcinoma.  Gastroenterology. 2003;  125 (6) 1626-1635
• 21 Vilgrain V, Mompoint D, Palazzo L. et al . Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT.  Am J Roentgenol. 1990;  155 (2) 277-281
• 22 Ziegler K, Sanft C, Zeitz M. et al . Evaluation of endosonography in TN staging of oesophageal cancer.  Gut. 1991;  32 (1) 16-20
• 23 Massari M, Cioffi U, De Simone M. et al . Endoscopic ultrasonography for preoperative staging of esophageal carcinoma.  Surg Laparosc Endosc. 1997;  7 (2) 162-165
• 24 Bhutani M S, Hawes R H, Hoffmann B J. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion.  Gastrointest Endosc. 1997;  45 474-479
• 25 Sawhney M S, Debold S M, Kratzke R A. et al . Central intranodal blood vessel: a new EUS sign described in mediastinal lymph nodes.  Gastrointest Endosc. 2007;  65 (4) 602-608
• 26 Vliet E P, Heijenbrok-Kal M H, Hunink M G. et al . Staging investigations for oesophageal cancer: a meta-analysis.  Br J Cancer. 2008;  98 (3) 547-557
• 27 Nishimaki van T, Tanaka O, Ando N. et al . Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer.  Ann Thorac Surg. 1999;  68 (6) 2059-2064
• 28 Romagnuolo J, Scott J, Hawes R H. et al . Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer.  Gastrointest Endosc. 2002;  55 (6) 648-654
• 29 Hofstetter W, Correa A M, Bekele N. et al . Proposed modification of nodal status in AJCC esophageal cancer staging system.  Ann Thorac Surg. 2007;  84 (2) 365-373
• 30 Chen J, Xu R, Hunt G C. et al . Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma.  Clin Gastroenterol Hepatol. 2006;  4 (5) 573-579
• 31 Vazquez-Sequeiros E, Norton I D, Clain J E. et al . Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma.  Gastrointest Endosc. 2001;  53 (7) 751-757
• 32 Doi S, Yasuda I, Iwashita T. et al . Needle tract implantation on the esophageal wall after EUS-guided FNA of metastatic mediastinal lymphadenopathy.  Gastrointest Endosc. 2008 [Epub ahead of print]; 
• 33 Janssen J, Dietrich C F, Will U. et al . Endosonographic elastography in the diagnosis of mediastinal lymph nodes.  Endoscopy. 2007;  39 (11) 952-957
• 34 Kanamori A, Hirooka Y, Itoh A. et al . Usefulness of contrast-enhanced endoscopic ultrasonography in the differentiation between malignant and benign lymphadenopathy.  Am J Gastroenterol. 2006;  101 (1) 45-51
• 35 Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (GEKID) in Zusammenarbeit mit dem Robert-Koch-Institut (RKI) .Krebs in Deutschland - Häufigkeiten und Trends. 5. Aufl. ISBN: 3-9 808 880-3-7. Saarbrücken; RoBo-Print Riegelsberg
• 36 Gotoda T. Endoscopic resection of early gastric cancer.  Gastric cancer. 2007;  10 1-11
• 37 Kwee R M, Kwee T C. Imaging in local staging of gastric cancer: a systematic review.  J Clin Oncol. 2007;  25 2107-2116
• 38 Kienle P, Buhl K, Kuntz C. et al . Prospective comparison of endoscopy, endosonography and computed tomography for staging of tumours of the oesophagus und gastric cardia.  Digestion. 2002;  66 230-236
• 39 Chen C H, Yang C C, Yeh Y H. Preoperative staging of gastric cancer by endoscopic ultrasound: the prognostic usefulness of ascites detected by endoscopic ultrasound.  J Clin Gastroenterol. 2002;  35 321-327
• 40 Kim K H, Song K S, Youn Y H. et al . Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer.  Gastrointest Endosc. 2007;  66 901-908
• 41 Lee Y T, Ng E K, Hung L C. et al . Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients.  Gut. 2005;  54 1541-1545
• 42 Chu K M, Kwok K F, Law S. et al . A prospective evaluation of catheter probe EUS for detection of ascites in patients with gastric carcinoma.  Gastrointest Endosc. 2004;  59 471-474
• 43 Ichikawa T, Kudo M, Matsui S. et al . Endoscopic ultrasonography with three miniature probes of different frequency is an accurate diagnostic tool for endoscopic submucosal dissection.  Hepatogastroenterology. 2007;  54 325-328
• 44 Yanai H, Noguchi T, Miizumachi S. et al . A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer.  Gut. 1999;  44 361-365
• 45 Hizawa K, Iwai K, Esaki M. et al . Is endoscopic ultrasonography indispensable in assessing the approriateness of endoscopic resection for gastric cancer?.  Endoscopy. 2002;  34 973-978
• 46 Botet J F, Lightdale C J, Zauber A G. et al . Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT.  Radiology. 1991;  181 426-432
• 47 Ziegler K, sanft C, Zeitz M. et al . Evaluation of endosonography in staging of oesophageal cancer.  Gut. 1991;  32 16-20
• 48 Kuntz C, Herfarth C. Imaging diagnosis for staging of gastric cancer.  Semin Oncol. 1999;  17 96-102
• 49 Zhong L, Li L, Sun J H. et al . Preoperative diagnosis of gastric cancer using 2-D magnetic resonance imaging with 3-D reconstruction techniques.  Chin J Dig Dis. 2005;  6 159-164
• 50 Sohn K M, Lee J M, Lee S Y. et al . Comparing MR imaging and CT in the staging of gastric carcinoma.  Am J Roentgenol. 2000;  174 1551-1557
• 51 Kang B C, Kim J H, Kim K W. et al . Value of the dynamic and delayed MR sequence with Gd-DTPA in the T-staging of stomach cancer: Correlation with the histopathology.  Abdom Imaging. 2000;  25 14-24
• 52 Polkowski M, Palucki J, Wronska E. et al . Endosonography versus helical computed tomography for locoregional staging of gastric cancer.  Endoscopy. 2004;  36 617-623
• 53 Arocena M G, Barturen A, Bujanda L. et al . MRI and endoscopic ultrasonography in staging of gastric cancer.  Rev Esp Enferm Dig. 2006;  98 582-590
• 54 Habermann C R, Weiss F, Riecken R. et al . Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US.  Radiology. 2004;  230 465-471
• 55 Tseng L J, Mo L R, Tio T L. et al . Video-endoscopic ultrasonography in staging gastric carcinoma.  Hepatogastroenterology. 2000;  47 897-900
• 56 Willis S, Truong S, Gribnitz S. et al . Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy.  Surg Endosc. 2000;  14 951-954
• 57 Bhandari S, Shim C S, Kim J H. et al . Usefullness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology.  Gastrointest Endosc. 2004;  59 619-626
• 58 Ang T L, Fock K M, Teo E K. Accuracy of endoscopic ultrasound staging of gastric cancer in routine clinical practice in Singapore.  Chin J Dig Dis. 2006;  7 191-196
• 59 Ganpathi I S, So J B, Ho K Y. Endoscopic ultrasonography for gastric cancer: does it influence treatment?.  Surg Endosc. 2006;  20 559-562