Mo1479 Staging of Esophageal and Junctional Cancer: Low Accuracy for EUS Tool in T2 N0 Patients

Abstract

Mo1479 Staging of Esophageal and Junctional Cancer: Low Accuracy for EUS Tool in T2 N0 Patients Germana De Nucci*, Emanuele Dabizzi, Maria C. Petrone, Sabrina G. Testoni, Davide Bona, Luigi Bonavina, Pier Alberto Testoni, Paolo G. Arcidiacono Gastroenterology and Gatrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy; Gastroenterology and Digestive Endoscopy, G. Salvini Hospital, Milan, Italy; Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy Background & Aim: Despite the poor prognosis of esophageal carcinoma (EC), the stage of the disease correlates with the length of survival and recommended treatment. Accurate staging of EC is important since it directs further management. After distant metastases have been ruled out by CT scanning or PET-CT, Endoscopic Ultrasound (EUS) is the best available tool in the preoperative locoregional staging, being able to define the depth of tumor invasion and to visualize and even sample locoregional lymph nodes. Accurate staging is important to define T2N0 cancers, which can proceed directly to surgery. When compared to surgical pathology, EUS showed to have about 85 % of accuracy in staging tumor depth and about 75 % in detecting regional lymph node metastases. Aim of the present study was to report a single high volume center’s experience with EUS staging in a rare subset of patients with T2N0 esophageal cancers, evaluating the accuracy of EUS staging for T2N0 tumors. Materials & Methods: We conducted a retrospective study from our database of patients, enrolled prospectively, that underwent EUS for staging EC between January 2010 and August 2014. We identified patients with T2N0 tumors who underwent surgical resection. The preoperative EUS staging (cTNM) was then compared to surgical pathology (pTNM) results to evaluate accuracy. Results: 509 patients underwent EUS for staging of EC. Of these, 43 patients (33 men, mean age 67 years) received a diagnosis of cT2N0 disease by EUS. Surgical resection of EC was performed after a mean of 11 days post-EUS. When compared to final pathologic outcomes, 40 % of patients (17/43) were evaluated correctly and referred for appropriate therapy, 49 % of patients (21/ 43) were understaged by EUS and 12 % of patients (5/43) were overstaged. Among the 21 understaged patients, understaging occurred due to tumor depth in 6 patients (29 %), nodal involvement in 7 patients (33 %) and both in 8 patients (38 %). The 5 overstaged patients had a histological T1b stage, without nodal involment. EUS showed an accuracy of 65 % in staging for tumor depth and of 82 % in staging for nodal involvement. Positive predictive value of EUS diagnosis of cT2N0 EC was 40 % (17 pT2N0/43 cT2N0). Conclusions: In this challenging group of patients with T2N0 tumors, EUS understaged EC in 49 % of cases resulting in surgical resection when neoadjuvant chemoradiation may have been beneficial. This underline that T2N0 EC is a branching point in the clinical decision making for the management of EC and that accurate clinical staging in patients with T2N0 EC is of paramount importance. Further improvement in EUS imaging quality at various depth is needed.