The Role of Endoscopic Ultrasound in the Evaluation of Barrett's Esophagus with High Grade Dysplasia or Intramucosal Carcinoma in the Surgical Patient

Abstract

Background: The accuracy and clinical utility of endoscopic ultrasound (EUS) in staging esophageal cancer is well established. The accuracy of EUS and its effect on the clinical management of patients with Barrett's esophagus (BE) and high grade dysplasia (HGD) or intramucosal carcinoma is not well established. Methods: Retrospective review of all patients who underwent EUS with standard 7.5 and 12 mHz Olympus radial echoendoscope for the evaluation of BE with HGD or intramucosal carcinoma without an endoscopic mass lesion over a 38 month period. Patients were evaluated for EUS T and N stage. EUS T and N stage was compared with surgical and pathologic staging. Management of patients was recorded and if EUS findings affected patient management. Results: EUS was perfomed on 20 patients. EUS stage was as follows T0 (10); T1 (9); T2 (1). All patients were EUS stage N0 with no EUS evidence of malignant appearing lymphadenopathy. No celiac axis lymph nodes were visualized. Surgical pathology from 16 esophagectomy specimens showed 1 patient with Barrett's metaplasia, 4 patients with low grade dysplasia, 6 patients with HGD, and 5 patients with carcinoma. Surgical T stage was as follows: T0 (11); T1 (5); T2 (0). All patients were surgical N0 with no malignant lymph nodes found in any patient at time of surgery. EUS T stage accuracy was (81%), N stage accuracy (100%). 16 patients underwent esophagectomy; 1 patient underwent PDT due to co-morbidities; 1 was lost to follow-up; in 2 patients surgery is pending. EUS staging did not change planned surgery in any patient. Conclusion: 1) EUS is accurate in staging patients with HGD or intramucosal CA in the esophagus 2) In patients with HGD or intramucosal carcinoma, EUS did not detect any unsuspected lymph node involvement or extension of tumor through the esophageal wall. 3) The surgically fit patient with BE and HGD or intramucosal carcinoma may be able to proceed directly to esophagectomy without EUS staging. Background: The accuracy and clinical utility of endoscopic ultrasound (EUS) in staging esophageal cancer is well established. The accuracy of EUS and its effect on the clinical management of patients with Barrett's esophagus (BE) and high grade dysplasia (HGD) or intramucosal carcinoma is not well established. Methods: Retrospective review of all patients who underwent EUS with standard 7.5 and 12 mHz Olympus radial echoendoscope for the evaluation of BE with HGD or intramucosal carcinoma without an endoscopic mass lesion over a 38 month period. Patients were evaluated for EUS T and N stage. EUS T and N stage was compared with surgical and pathologic staging. Management of patients was recorded and if EUS findings affected patient management. Results: EUS was perfomed on 20 patients. EUS stage was as follows T0 (10); T1 (9); T2 (1). All patients were EUS stage N0 with no EUS evidence of malignant appearing lymphadenopathy. No celiac axis lymph nodes were visualized. Surgical pathology from 16 esophagectomy specimens showed 1 patient with Barrett's metaplasia, 4 patients with low grade dysplasia, 6 patients with HGD, and 5 patients with carcinoma. Surgical T stage was as follows: T0 (11); T1 (5); T2 (0). All patients were surgical N0 with no malignant lymph nodes found in any patient at time of surgery. EUS T stage accuracy was (81%), N stage accuracy (100%). 16 patients underwent esophagectomy; 1 patient underwent PDT due to co-morbidities; 1 was lost to follow-up; in 2 patients surgery is pending. EUS staging did not change planned surgery in any patient. Conclusion: 1) EUS is accurate in staging patients with HGD or intramucosal CA in the esophagus 2) In patients with HGD or intramucosal carcinoma, EUS did not detect any unsuspected lymph node involvement or extension of tumor through the esophageal wall. 3) The surgically fit patient with BE and HGD or intramucosal carcinoma may be able to proceed directly to esophagectomy without EUS staging.