The Accuracy of EUS Staging as Compared to Laparoscopic Staging of Esophageal Cancer

Abstract

Purpose: Invasive surgical staging of esophageal cancer is considered to be more accurate than non-invasive staging modalities. Many centers perform laparoscopic staging (LS) in addition to non-invasive staging (CT/PET/EUS). We sought to compare the accuracy of EUS staging and LS in esophageal cancer. Methods: All new cases of EUS-staged esophageal cancer over an 18 month period (12/01 - 6/03) were reviewed retrospectively. The study cohort included those patients who underwent both EUS and LS. For the purposes of this study, LS was considered the gold standard for nodal and occult metastases rather than surgical resection, as many patients received neoadjuvant therapy. Failed EUS staging was defined as the inability to pass the radial echoendoscope (Olympus GF-UM130) through the malignant stricture despite dilation. Results: A total of 105 patients underwent EUS staging for newly diagnosed esophageal cancer during the study period. 86 patients (82%) had a complete EUS exam. 45 patients (43%) underwent both EUS and LS; these patients comprised the study cohort. 32 patients (71%) had complete and 13 patients (29%) had incomplete EUS evaluation in this cohort. Of the 32 patients who had complete EUS evaluation, EUS staging accuracy was 78% as compared to LS. 3 patients (9%) were understaged by EUS, and 4 patients (13%) were overstaged by EUS as compared to LS. When EUS was accompanied by fine needle aspiration (EUS-FNA), the staging accuracy increased to 91%. All 4 patients overstaged by EUS had malignant appearing celiac nodes in which intervening tumor precluded FNA. Of the patients that failed EUS evaluation, 6 (46%) were understaged by EUS and 7 (54%) had no change by LS. Conclusion: EUS is an accurate staging modality for esophageal cancer. EUS-FNA of all suspicious lymph nodes and occult metastases should be pursued to increase staging accuracy. LS should be reserved for cases where EUS evaluation is incomplete due to inability to traverse the malignant stricture.