Staging Accuracy of Endoscopic Ultrasound Based on Pathologic Analysis after Minimally Invasive Esophagectomy

Abstract

Endoscopic ultrasonography (EUS) is a common staging modality used in patients with esophageal cancer. The objective of this analysis was to evaluate the accuracy and sensitivity of EUS in determining the depth of penetration (T stage) and nodal status (N stage) in patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE). A retrospective analysis of all patients at a university hospital who underwent preoperative EUS followed by MIE for cancer was performed. We compared the results of preoperative EUS to final pathologic analyses of the esophageal specimen, examining the accuracy of EUS staging. Ninety-five patients with esophageal cancer who underwent MIE had preoperative EUS. Twenty-four of the 95 patients were excluded for lack of a repeat EUS after neoadjuvant therapy before resection. Hence, 71 patients were evaluated for the accuracy of EUS staging. The accuracy of EUS for TO disease was 80 per cent; T1 disease was 75 per cent; T2 disease was 39 per cent; and T3 disease was 88 per cent. The overall EUS accuracy for T stage was 72 per cent with overstaging occurring mostly for pathologic T1 tumors in 18 per cent and understaging occurring mostly for pathologic T3 tumors in 11 per cent. The sensitivity and specificity for detection of nodal involvement were 79 per cent and 74 per cent, respectively. However the accuracy for T and N staging by EUS after neoadjuvant therapy decreased to 63 per cent and 38 per cent, respectively. Endoscopic ultrasound in the absence of neoadjuvant therapy is a relatively accurate and sensitive modality for determining the depth of tumor penetration and the presence of nodal disease in patients with esophageal carcinoma. The accuracy for T and N staging is less reliable after neoadjuvant therapy.