Tumor Related Factors Influencing the Accuracy of Endoscopic Ultrasound in Cancer of the Esophagus and the Gastro-esophageal Junction

Abstract

Background: Endoscopic Ultrasound (EUS) is the most accurate method to assess the extent of the tumor and involvement of locoregional lymph nodes in patients with cancer of the esophagus or gastro-esophageal junction (GEJ). Especially in combination with Fine Needle Aspiration (FNA), EUS is the first line method to assess the lymph nodes at celiac axis. Tumor related factors and patients characteristics that might influence the accuracy of EUS were examined. Patients and Methods: Between January 1997 and September 2002, 280 patients underwent EUS for cancer of the esophagus or GEJ. Retrospectively, the influence of patients characteristics, presence of Barrett's epithelium or stenosis, histopathology, localization and length of the primary tumor on the accuracy of EUS was examined. Results: Overall accuracy of EUS to assess T-, N- and M-stage were 73%, 80% and 78%, respectively. Age and sex, histopathology, presence of Barrett's epithelium or stenosis did not influence the accuracy. However, the accuracy of EUS was higher in tumors <5 cm compared with tumors >5 cm (82% vs 52% for T-stage; 88% vs 59% for N-stage; 92% vs 56% for M-stage). Accuracy of EUS was significantly higher for esophageal tumors compared to GEJ tumors, especially in determining celiac trunk metastases (93% vs 63%: p<0.001). Conclusion: The accuracy of EUS is lower in tumors >5 cm and in tumors of the GEJ as compared with tumors of <5 cm and above the gastro-esophageal junction.