The Impact of Time Elapsed Between Endoscopic Ultrasound and Esophagectomy on Concordance of Ultrasonographic and Pathologic Staging of Esophageal Malignancy

Abstract

Endoscopic ultrasound (EUS) is frequently used for staging of esophageal malignancies prior to esophagectomy. The purpose of this study was to evaluate the effect of elapsed time between endoscopic ultrasound (EUS) staging and esophagectomy on the accuracy of EUS T- and N-staging. This was a retrospective case series of 45 patients with esophageal malignancy who underwent staging EUS and subsequent esophagectomy at our center without neoadjuvant therapy between 2000 and 2009. The main outcome measurements were accuracy of EUS T- and N-staging when compared with surgical pathology. EUS staging was accurate in 55.6% of patients for tumor stage, and in 75.6% of patients for nodal stage. The median time between EUS and esophagectomy was 26days (range 3-64). Among patients with surgery performed 3-15, 16-30, and 31-64days after EUS, EUS tumor staging was accurate in 90.9, 47.4, and 40.0%, respectively (P=0.02). EUS nodal staging among patients with surgery performed 3-15, 16-30, or 31-64days after EUS was accurate in 63.6, 84.2, and 73.3% of cases, respectively (P=0.44). Among the 20 patients for whom T-stage was discordant, 45% were understaged and 55% were overstaged by EUS. There were 11 patients in whom N-stage was discordant; 45.5% were understaged and 54.5% were overstaged. Pathologic T-staging is concordant with EUS T-staging when esophagectomy is performed within 15days of endoscopic evaluation. Correlation between EUS and pathologic N-staging is unlikely to be affected by length of time between EUS and esophagectomy.