Endoscopic ultrasound in esophageal carcinoma
- Maurits J Wiersema, MD
Maurits J Wiersema, MD
- Clinical Assistant Professor of Medicine
- Indiana University School of Medicine
The prognosis of esophageal cancer is strongly associated with its stage. As a result, accurate clinical staging is critical for selecting appropriate treatment options. Endoscopic ultrasonography (EUS) has a central role in the initial staging of esophageal carcinoma and may also be useful for detecting disease recurrence.
This topic review will focus on the role of EUS in the care of patients with esophageal carcinoma. An overview of the diagnosis and staging of esophageal carcinoma is presented separately. (See "Diagnosis and staging of esophageal cancer".)
Initial evaluation of the patient diagnosed with esophageal carcinoma centers on the assessment of operative risk and tumor stage. Comorbid conditions may preclude a patient with a potentially resectable tumor from undergoing surgery. Preoperative tumor staging is warranted in patients who are considered to be surgical candidates because their disease extent will influence treatment planning (eg, it may reveal that a patient is a candidate for endoscopic resection). (See "Surgical management of resectable esophageal and esophagogastric junction cancers" and "Management of superficial esophageal cancer", section on 'Endoscopic resection'.)
Staging usually begins with a computed tomography (CT) scan to evaluate for the presence of metastatic disease. However, with increasing availability, positron emission tomography (PET) CT fusion scanning may be more accurate for the detection of stage IV disease, and can be used as an initial staging assessment. (See "Diagnosis and staging of esophageal cancer".)
A more detailed evaluation of locoregional disease extent (T and N stage) should be obtained if distant metastases are not demonstrated. A number of studies have demonstrated that EUS is more accurate than transabdominal ultrasound, CT scan, magnetic resonance imaging (MRI), or PET scanning for locoregional staging of esophageal carcinoma [1-17]. Overall, study results will be influenced by the number of early versus advanced T-stage patients as EUS is more accurate in the latter population. A strong correlation exists between tumor differentiation, T-stage and lymph node status . A meta-analysis of diagnostic test characteristics made the following estimates for EUS, CT, and PET scanning, concluding that the three approaches were complementary :
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- PREOPERATIVE STAGING
- Histologic correlates of the endoscopic ultrasound image
- EUS for T staging of superficial tumors
- EUS for staging advanced tumors
- Accuracy of EUS for determining unresectability
- EUS for preoperative lymph node staging
- - Endoscopic ultrasound-guided fine-needle aspiration biopsy
- Interobserver variation and EUS learning curve for esophageal carcinoma staging
- RESTAGING AFTER NEOADJUVANT THERAPY
- DETECTION OF LOCOREGIONAL RECURRENCE
- SUMMARY AND RECOMMENDATIONS