Overall Accuracy Of Endoscopic Ultrasonography Research Articles

Establishment and validation of a risk score model based on EUS: assessment of lymph node metastasis in early gastric cancer

Lymph node metastasis significantly affects the prognosis of early gastric cancer patients. Endoscopic ultrasonography (EUS) plays a crucial role in the preoperative assessment of early gastric cancer. This study evaluated the efficacy of EUS in identifying lymph node metastasis in early gastric cancer patients and developed a risk score model to aid in choosing the best treatment options. We retrospectively analyzed the effectiveness of EUS for detecting lymph node metastasis in early gastric cancer patients. A risk score model for predicting lymph node metastasis preoperatively was created using independent risk factors identified through binary logistic regression analysis and subsequently validated. Receiver operating characteristic (ROC) curves were generated for both the development and validation cohorts. The overall accuracy of EUS in identifying lymph node metastasis was 85.3%, although its sensitivity (29.2%) and positive predictive value (38.7%) were relatively low. Patients were categorized based on preoperative risk factors for lymph node metastasis, including tumor size ≥20 mm, lymph nodes ≥10 mm, BMI ≥24 kg/m2, and lymph node metastasis on CT scans. A 7-point risk score model was developed to assess the likelihood of lymph node metastasis. The areas under the ROC curve (AUCs) for the development and validation sets were 0.842 and 0.837, respectively, with sensitivities of 64% and 79%, respectively. We developed a practical risk score model based on preoperative factors to help EUS predict lymph node metastasis in early gastric cancer patients, guiding the selection of optimal treatment approaches for these patients.

Accuracy of Endoscopic Ultrasonography for Determining the Depth of Invasion in Early Gastric Cancer.

Background:Accurate staging for depth of invasion (T stage) of early gastric cancer is critical for determining the treatment modality. Endoscopic ultrasonography is a reliable method for assessing the T stage. However, its diagnostic accuracy varies. The aim of this study is to investigate clinicopathologic factors affecting the diagnostic accuracy of endoscopic ultrasonography in early gastric cancer.Methods:Patients with early gastric cancer who had undergone endoscopic resection or gastrectomy were included. The diagnostic accuracy of endoscopic ultrasonography was evaluated by comparing the T stage by endoscopic ultrasonography with histopathology of the resected specimen. Subgroup analysis was performed according to the endoscopic resection criteria.Results:A total of 223 early gastric cancer lesions were included. The overall accuracy of endoscopic ultrasonography for T staging was 66.4%. The diagnostic accuracy for lesions ≤2 cm was significantly higher than for those of 2-3 cm (odds ratio 3.59) or those >3 cm (odds ratio 5.47). The diagnostic accuracy was significantly decreased in lesions with ulceration (odds ratio 2.62) or non-flat morphology (odds ratio 2.94). The accuracy of endoscopic ultrasonography for lesions corresponding to the absolute endoscopic resection criteria was significantly higher than for those corresponding to the expanded criteria (97.3% vs 71.9%, P = .002). Of the tumors that were overestimated by endoscopic ultrasonography treated with gastrectomy, 93.3% corresponded to the expanded criteria.Conclusion:Endoscopic ultrasonography had poor accuracy in early gastric cancer lesions larger than 2 cm, those with ulceration, and those with non-flat morphology, that is, lesions corresponding to the expanded criteria were more frequently overstaged by endoscopic ultrasonography. Such early gastric cancers should be carefully considered when staging by endoscopic ultrasonography before gastrectomy.

Diagnostic Efficacy and Decision-Making Role of Preoperative Endoscopic Ultrasonography in Early Gastric Cancer.

Objectives: Endoscopic ultrasonography (EUS) is the most commonly used method for T staging of early gastric cancer (EGC). However, the studies pertaining to EUS for staging EGC reported widely varied sensitivities and specificities. This study aimed to estimate the overall diagnostic accuracy of EUS for staging the depth of EGCs and to explore the influential factors.Methods: We retrospectively reviewed data from 208 consecutive patients with EGC, and all patients underwent EUS for estimating tumor invasion depth, followed by either curative surgery or endoscopic submucosal dissection (ESD). The diagnostic accuracy of EUS was evaluated by comparing the final histologic results of resected specimens. The correlation between accuracy of EUS and characteristics of EGC lesion was analyzed.Results: A total of 211 EGC lesions in 208 patients were included. The overall diagnostic accuracy of EUS in assessing the tumor invasion depth of EGC was 55.9%. Multivariate analysis showed that submucosal invasion (OR 2.615; 95% CI 1.203–5.684, P = 0.015) was independently associated with misdiagnosis of the depth of EGC and 0-III type lesions (OR 31.495; 95% CI 2.083–476.256, P = 0.013) were an independent risk factor for over-diagnosis of invasion depth by EUS. However, EUS was only suitable for lesions within absolute indications for endoscopic resection.Conclusions: The overall accuracy of EUS in diagnosing invasion depth of EGC was relatively low. Thus, EUS is not necessary routinely for determining the therapeutic strategy for EGC.

Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors.

Background/AimsEndoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results. MethodsWe retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests. ResultsThe overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa. ConclusionsAPCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies.

Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.

Endoscopic ultrasonography for pretreatment T‑staging of gastric cancer: An in�vitro accuracy and discrepancy analysis

In the current era of multi-disciplinary treatment, precise and detailed diagnosis prior to treatment is crucial for clinical practice. For different lesions that fit different indications, the optimum approach for treatment differs significantly. Thus, the recent 8th American Joint Committee on Cancer classification system has introduced ‘clinical stage’ as a criterion. Endoscopic ultrasonography (EUS) has been the first-line choice for pretreatment staging; however, there is no standardization of the depth classification nor a standard EUS method. Additionally, the accuracy for this diagnostic test has ranged between <40 and 90% in previous studies. The aim of the present study was to determine the accuracy of EUS, identify the discrepancies between EUS and histological results, and analyze the underlying causes. Between June 2014 and February 2016, EUS was performed on gastric carcinoma specimens from 60 consecutive patients. EUS was performed on the resected specimens following surgery, but prior to fixation in formalin, invasion of the gastric wall was determined and the deepest location was marked with sutures. The ultrasound images were independently interpreted, and the quality of the images was scored by two endoscopists. Subsequently, the ultrasound images were compared with the pathological results of the same section. The overall accuracy of EUS was 75%. For locally advanced gastric cancers, EUS had a relatively high accuracy (33/43, 86%). The EUS results corresponded well with the pathological hematoxylin and eosin staining results, and the deepest points determined by EUS were confirmed by pathology in the majority of cases (85%). In total, 50 and 10 cases were scored as having high/moderate and low quality, associated with accuracies of 86% (43/50) and 20% (2/10), respectively. EUS is valuable for pretreatment T-staging, particularly for advanced cases. Proximal stomach cancer exhibited a tendency for improved accuracy. Overall, the results of the present study suggest that standardized scanning processes, particularly including all-encompassing scanning, proper probe-placement and high image quality, lead to improved accuracy of EUS.

Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors.

Incidental gastric subepithelial tumor (SET) is frequently found during endoscopy. Although endoscopic ultrasonography (EUS) can provide useful information, its diagnostic accuracy varies. Most of the potentially malignant tumors observed on EUS are hypoechoic lesions. Therefore, we aimed to investigate the diagnostic accuracy of EUS for hypoechoic lesions located in the submucosa or proper muscle layer. We also evaluated various characteristics for potential associations with diagnostic accuracy.A retrospective review was conducted of the medical records of 99 patients who were diagnosed with gastric SET and who underwent EUS with pathologic confirmation between March 2008 and April 2015. After reviewing the endoscopic and pathologic findings, we attempted to analyze factors that were associated with the diagnostic accuracy of EUS.The mean ± standard deviation size of the lesions was 20.0 ± 12.7 mm. The most common location was the upper third of the stomach (43.4%). The overall accuracy of EUS was 66.7%. No statistically significant difference in EUS accuracy was observed according to the location, size, or layer of the lesion. The following pathologic diagnostic methods were used: EUS-guided fine needle aspiration (3.0%), forceps biopsy (16.2%), deep tissue biopsy using cap-assisted mucosal resection (8.1%), endoscopic submucosal dissection (25.2%), and operation (47.5%). The accuracy of EUS according to the expected diagnosis of the lesion was 77.1% for gastrointestinal stromal tumor, 50% for neuroendocrine tumor, and 50% for ectopic pancreas.Although EUS is a useful tool for gastric SET in clinical practice, the accuracy of diagnostic EUS is suboptimal. When considering whether to treat gastric SET, the decision should be made based on the pathologic diagnosis.

A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer.

The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer. Initial EUS examinations for treatment-naïve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups. The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3%, P=0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5%, P=0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95% confidence interval (CI), 66.5-92.5%] and 62.9% (95% CI, 60.5-66.9%) in the cardiac and non-cardiac cancer groups, respectively (P=0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95% CI)=2.242 (1.156-4.349)]. The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.

Gastric cancer-can we rely only on endoscopic ultrasonography?

Endoscopic ultrasonography (EUS) is considered to be the most precise method for locoregional staging, was commonly used for differentiating mucosal lesions from submucosal lesions. By contrast, computed tomography (CT) was used to detect the presence of distant metastasis. Both are valuable tools for the pre-operative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and multidetector CT (MDCT) is needed. The present study was conducted to compare the staging accuracy of EUS with that of MDCT in series of patients and to evaluate their usefulness in association with the clinicopathological factors. In total, 277 patients with gastric lesions who underwent EUS and CT, hospitalized at Department of Gastroenterology and Hepatology, Clinical Center, University of Sarajevo. The results from the pre-operative EUS and MDCT were compared with the post-operative pathological findings. Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. For the pre-operative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.

Current status and future applications of contrast-enhanced endoscopic ultrasonography.

Endoscopic ultrasonography (EUS) is currently an integral investigation of many gastrointestinal disorders. It has been shown to have a higher efficacy than conventional computed tomography in detection and characterization of small lesions especially in the pancreas. Much effort has been put to further improve the sensitivity, specificity and overall accuracy of EUS. One of the major advances is the utilization of contrast agents for better delineation of the vascularity and tissue perfusion of the target lesion. This article describes the basic principles of ultrasound contrast agents and the different modalities used in contrast-enhanced EUS (CE-EUS) including contrast-enhanced Doppler EUS (CED-EUS) and contrast-enhanced harmonic EUS (CEH-EUS). In addition, the current applications of contrast enhanced EUS in different gastrointestinal conditions were discussed. Furthermore, the future development of hybrid approaches combining CE-EUS with other imaging modalities and the potential therapeutic aspect of using it as a vector for drug delivery were also discussed.

Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer

BackgroundThe accuracy of endoscopic ultrasonography (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS tumor (T) and node (N) staging, and to identify the histopathological factors influencing accuracy based on the detailed tumor depth of gastric cancer.MethodsIn total, 309 patients with gastric cancer with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary’s Hospital, Korea, between January and December 2009. The T and N staging of EUS and the pathologic report were compared.ResultsThe overall accuracies of EUS for T stage and the detailed T stages were 70.2% and 43.0%, respectively. In detailed stage, tumors greater than 50 mm in diameter were significantly associated with T overstaging (odds ratio (OR) = 2.094). The overall accuracy of EUS for N staging was 71.2%. Tumor size (20 mm ≤ size < 50 mm, OR = 4.389; and 50 mm ≤ size, OR = 8.170), cross-sectional tumor location (circumferential, OR = 4.381) and tumor depth (submucosa, OR = 3.324; muscular propria, OR = 6.923; sub-serosa, OR = 4.517; and serosa-exposed, OR = 6.495) were significant factors affecting incorrect nodal detection.ConclusionsCareful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging.

Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector‐row computed tomography

The aim of this study was to determine the accuracy of endoscopic ultrasonography (EUS) and multidetector-row computed tomography (MDCT) for the locoregional staging of gastric cancer. EUS and computed tomography (CT) are valuable tools for the preoperative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and MDCT is needed. In total, 277 patients who underwent EUS and MDCT, followed by gastrectomy or endoscopic resection at Bundang Hospital, Seoul National University, from July 2006 to April 2008, were analyzed. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. For the preoperative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.

Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer

Endoscopic ultrasonography (EUS) has been a useful method for the accurate staging of esophageal cancer. This study aimed to compare the diagnostic performance of EUS, positron emission tomography (PET), and computed tomography (CT) in the locoregional staging of resectable esophageal cancer. A total of 109 patients with resectable esophageal cancer were prospectively enrolled and retrospectively reviewed for evaluation of preoperative EUS, PET, and CT. The sensitivity, specificity, and accuracy of tumor depth (T) staging and regional lymph nodal (N) staging for each test were compared with the postoperative histopathologic stage as the gold standard. The overall accuracy of EUS for T staging was 72%, and it was the only method for delineating the layers of the esophageal wall. The sensitivities for N staging were 42% for EUS, 49% for PET, and 35% for CT, and their specificities were, respectively, 91, 87, and 93%. The accuracy for N staging was 66% for EUS, 68% for PET, and 63% for CT, and it did not differ significantly across the three tests. Preoperative EUS for the locoregional staging of esophageal cancer provides excellent T staging accuracy and similar accuracy for N staging compared with PET and CT. Especially in T staging, EUS could play an important role in the choice of candidates for esophageal cancer surgery.

Lymph node staging in esophageal squamous cell carcinoma: A comparative study of endoscopic ultrasonography versus computed tomography

Endoscopic ultrasonography (EUS) is established as a standard approach for locoregional staging of esophageal cancer. However, only a few published studies have attempted to correlate the station of the abnormal lymph nodes detected by EUS with the definitive histology. We compared EUS and computed tomography (CT) in the initial staging of esophageal squamous cell carcinoma. Consecutive patients with esophageal cancer undergoing EUS were evaluated. EUS findings and patient data including histopatology were collected prospectively and analyzed retrospectively. Lymph node locations were divided into three groups; abdominal (A), paraesophageal (B), and thoracic paratracheal (C). A total of 365 consecutive patients underwent EUS and 159 patients underwent esophagectomy without neoadjuvant chemotherapy. Thirty-eight patients were excluded (insufficient EUS, etc.), and 121 patients were enrolled. The overall accuracy of EUS was 64% (sensitivity 68%, specificity 58%, positive predictive value [PPV] 68%), CT was 51% (sensitivity 33%, specificity 75%, PPV 64%), and CT + EUS was 64% (sensitivity 74%, specificity 50%, PPV 66%). The accuracy of EUS was higher than CT in Groups A and C. Sensitivity of CT was lower than that of EUS alone and CT + EUS. This study has demonstrated that EUS is a more accurate technique than contrast-enhanced CT for detecting abnormal lymph nodes. Sensitivity of CT was lower than that of EUS alone and CT + EUS. But some metastatic lymph nodes in neck and abdominal fields are only detectable by CT. Therefore, both EUS and CT should be undertaken for routine examination prior to treatment of esophageal cancer.

The efficiency of endoscopic ultrasound in pretherapeutic assessment of the depth of invasion in early gastric cancer

Aim: Increased applications of endoscopic mucosal resection (EMR) and laparoscopic surgery accentuate the importance of accurate evaluation of the depth of invasion in the treatment of early gastric cancer (EGC). We evaluated the efficiency of endoscopic ultrasonography (EUS) in the staging of EGC. Methods: The accuracy of EUS in pretherapeutic evaluation of EGC was analyzed retrospectively. Pathologically proven 53 gastric cancers with suspicion of early stage by endoscopy and CT were evaluated with EUS followed by surgical (37 cases) or endoscopic resections (16 cases). The results of EUS staging were compared to the postresection histological staging. Results: The overall accuracy of EUS in differentiation between mucosal (m) and submucosal (sm) cancer was 62.3%. The depth of m and sm cancers was correctly assessed by EUS as 58% and 70%, respectively. The rate of overstaging was 32.1%(17/53) while that of understaging was only 5.7%(3/53). One case of EMR needed further treatment. Statistical analysis was carried out to verify the factors that affect the accuracy of EUS. The included variables were size, groß type, site, differentiation, associated intestinal metaplasia, and Ming & Lauren classification of tumor. Differentiation of tumor showed statistical significance (p<0.03) on diagnostic accuracy of EUS. Well differentiated adenocarcinoma had the tendency of accurate EUS staging. Conclusions: Endoscopic mucosal resection is a good modality for the treatment of EGC. However, when the patients are not accurately selected, EMR should be followed by additional second stage surgical treatment. Although the accuracy of EUS in differentiation of m and sm gastric cancer was relatively lower in this study, higher accuracy in well differentiated adenocarcinoma and the overstaging tendency have positive aspect of reducing the necessity of second stage operation.

Accurate diagnosis of pancreas divisum by linear-array endoscopic ultrasonography.

During linear-array endoscopic ultrasonography (EUS), the main pancreatic duct can be followed continuously from the major papilla into the pancreatic body in most patients. Often, the duct can also be seen crossing a sonographic border between the ventral and dorsal pancreatic anlagen. It was hypothesized that the presence of either feature excludes pancreas divisum, whereas the absence of these features suggests complete pancreas divisum. Pancreas divisum was sought during all linear-array EUS examinations conducted between July 1999 and June 2003. Charts were reviewed retrospectively, and patients who underwent endoscopic retrograde pancreatography after, but not before, EUS were included in the study. A total of 162 patients had EUS before ERCP. Adequate evaluation of the pancreatic duct was possible in 78 % of the patients. The prevalence of pancreas divisum was 13.6 %. In patients with adequate duct visualization, the sensitivity, specificity, and positive and negative predictive values for EUS were 95 %, 97 %, 86 %, and 99 %, respectively. The overall accuracy of EUS for identifying pancreas divisum was 97 % in this subgroup. Adequate EUS evaluation of pancreas divisum was possible in most cases. Linear-array EUS is a promising diagnostic test for pancreas divisum.

Staging of esophageal carcinoma

J Thorac Cardiovasc Surg 2003;125:988-91

Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy

Background. In past years multimodal neoadjuvant treatment for carcinoma of the esophagus has been used with increased frequency. Staging of the neoplasm still remains fundamental in evaluating the response to therapy and in planning operation. The aim of the present study was to assess the accuracy of endoscopic ultrasonography (EUS) in a group of patients with squamous cell carcinoma of the thoracic esophagus after undergoing radiotherapy and chemotherapy. Methods. Among a group of 111 patients with squamous cell carcinoma of the thoracic esophagus and treated with preoperative radiotherapy and chemotherapy, 87 were operated. In these patients it was possible to compare the results of EUS, with regard to depth of invasion of esophageal wall (T) and lymph node involvement (N), with the results of operation and histopathologic study. Results. Feasibility of EUS before and after neoadjuvant treatment was 71.2% and 83.9%, respectively. The overall accuracy of EUS regarding the wall invasion was 47.9%. The more frequent error was overstaging, especially in patients with complete response and in patients with minimal residual disease. In the assessment of lymph node involvement, EUS showed an overall accuracy of 71.2% with a moderate κ value. Sensitivity for N1 and N0 was 73.7% and 68.6%, respectively. Conclusions. Endoscopic ultrasonography was feasible in most patients after preoperative radiotherapy and chemotherapy, but our study documented a worsening of accuracy of EUS in the evaluation of T attributable to the confounding presence of radiation fibrosis and soft tissue reaction after radiotherapy and chemotherapy.

Cytologic examination of pancreatic juice for differential diagnosis of benign and malignant mucin producing tumors of the pancreas

A new clinical type of pancreatic tumor, the mucin-producing tumor, has been recognized recently. However, it is not always easy to distinguish benign from malignant tumors preoperatively. In this study, three different methods of differentiating mucin-producing tumors of the pancreas were compared. Endoscopic ultrasonography, endoscopic retrograde pancreatography, and cytologic examination of pancreatic juice were performed in 14 patients who had mucin-producing pancreatic tumors (11 carcinomas and 3 adenomas). Pancreatic juice was collected endoscopically without papillotomy. The sensitivity, specificity, and overall accuracy of endoscopic ultrasonography were 82%, 90%, and 79%, respectively; those of endoscopic retrograde pancreatography were 91%, 91%, and 86%; and those of cytologic examination were 91%, 100%, and 93%. Cytologic examination of pancreatic juice was the best of these three methods for differentiating benign from malignant mucin-producing pancreatic tumors.

Endosonography for Preoperative Locoregional Staging of Esophageal and Gastric Cancer

To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal and gastric carcinoma, we performed a prospective controlled study over a five year period. Data from 63 patients with esophageal cancer and 147 patients with gastric cancer who underwent surgery were available for comparison of the endosonographic TNM classification to the histophathological findings of the resected specimens. The overall accuracy of EUS in the assessment of tumor infiltration depth was 85.7% and 78% in esophageal and gastric cancer, respectively. The sensitivity of EUS in the detection of regional lymph node metastases was 90% in esophageal and 87% in gastric carcinoma. The most frequent causes of misdiagnoses by endosonography were microscopic tumor invasion and peritumorous inflammatory changes. The inability to traverse a tumor stenosis restricted the endosonographic evaluation in 31.6 and 14% of the cases with esophageal and gastric cancer, respectively.