Endoscopic ultrasonography in preoperative staging of esophageal cancer

Thirty-two consecutive patients with esophageal carcinoma (squamous cell carcinoma: 23, adenocarcinoma: 9) were pre-operatively examined by endoscopic ultrasonography (EUS) in order to evaluate the accuracy of this diagnostic procedure in loco-regional staging. Six patients were not operated on, due to a poor general conditions or widespread tumor disease and were not included in this study. Results of EUS staging from the remaining patients were compared with intra-operative exploration and histopathological evaluation of resection specimens. Seven stenosing tumors were not traversable by echoendoscope. In such cases the lesion was visualized only in part by scanning the top of the stenosis. The overall EUS accuracy in T staging was 80.7% (75% in T2 stage, 90.9% in T3, 71.4% in T4). Three tumors were overstaged; two not traversable stenosing tumors were understaged. The overall accuracy in N staging was 73% (sensitivity 77.7%, specificity 62.5%). For celiac nodes EUS sensitivity was only 57.1%. Authors conclude that the presence of a not traversable stenosis is still a limit for EUS in diagnosing infiltration of adjacent structures as well as in detecting lymph node metastases.