Accuracy of EUS in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma

Gastrointest Endosc. 2001 Dec;54(6):689-96. doi: 10.1067/mge.2001.119216.

Abstract

Background: Nonoperative therapy with intent to cure may be considered for patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma. However, a more advanced stage of disease must be precluded before such treatment. The potential of EUS for this purpose was evaluated.

Methods: EUS was performed in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma based on endoscopy, endoscopic biopsies, and CT before esophagectomy. EUS findings were compared with surgical/pathologic evaluation.

Results: EUS suggested submucosal invasion in 6 patients and lymph node involvement in 5 patients. By surgical/pathologic evaluation, 5 of 22 patients (23%) had unsuspected submucosal invasion and 1 had lymph node involvement. EUS detected all 5 instances of submucosal invasion and the single instance of lymph node involvement. EUS was falsely positive for submucosal invasion in 1 patient and for lymph node involvement in 4 patients. Sensitivity, specificity, and negative predictive values of preoperative EUS for submucosal invasion were 100%, 94%, and 100%, and for lymph node involvement were 100%, 81%, and 100%, respectively. A nodule or stricture noted by endoscopy was associated with an increased likelihood of submucosal invasion.

Conclusions: In patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma, EUS detected otherwise unsuspected submucosal invasion and lymph node involvement. Patients should be evaluated with EUS when nonoperative therapy is contemplated.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Aged
  • Barrett Esophagus / diagnostic imaging*
  • Barrett Esophagus / mortality
  • Barrett Esophagus / pathology*
  • Barrett Esophagus / surgery
  • Biopsy, Needle
  • Confidence Intervals
  • Endosonography / methods*
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery
  • Esophagectomy / methods
  • Esophagoscopy / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mucous Membrane / pathology
  • Probability
  • Registries
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tomography, X-Ray Computed
  • Treatment Outcome