Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2017; 23(46): 8193-8199
Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8193
Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation?
Carrie Luu, Marisa Amaral, Jason Klapman, Cynthia Harris, Khaldoun Almhanna, Sarah Hoffe, Jessica Frakes, Jose M Pimiento, Jacques P Fontaine
Carrie Luu, Marisa Amaral, Jacques P Fontaine, Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Jason Klapman, Cynthia Harris, Khaldoun Almhanna, Jose M Pimiento, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Sarah Hoffe, Jessica Frakes, Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Author contributions: Luu C provided the conception and design; Fontaine JP contributed to acquisition, analysis, or interpretation of data; all authors drafted, revised and finally approved of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at Moffitt Cancer Center.
Informed consent statement: This is a retrospective study using de-identified clinical data that was obtained after approval from the institution’s IRB. Since all information was anonymous and does not impact patients in any way, no patient consent was required.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jacques P Fontaine, MD, Associate Member, Department Thoracic Oncology, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, United States. jacques.fontaine@moffitt.org
Telephone: +1-813-7453050 Fax: +1-813-7453027
Received: January 23, 2017
Peer-review started: January 27, 2017
First decision: May 12, 2017
Revised: July 4, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: December 14, 2017
Abstract
AIM

To evaluate the accuracy of endoscopic ultrasound (EUS) in early esophageal cancer (EC) performed in a high-volume tertiary cancer center.

METHODS

A retrospective review of patients undergoing esophagectomy was performed and patients with cT1N0 and cT2N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student’s t test and Fisher’s exact test or χ2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy.

RESULTS

Between 2000 and 2015, 139 patients with clinical stageIorIIA esophageal cancer undergoing esophagectomy were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle third of the esophagus in 11 (8%) and lower third and gastroesophageal junction in 128 (92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. Positron emission tomography (PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients (6%) in whom both EUS and PET were negative for nodal involvement.

CONCLUSION

EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.

Keywords: Esophageal cancer, Endoscopic ultrasound, Staging, Early esophageal cancer, Endoscopic mucosal resection

Core tip: Endoscopic ultrasound (EUS) is an important and widely used staging modality in esophageal cancer. However, our study corroborates other reports that EUS is less accurate in early cancer. The use of positron emission tomography in this setting improves rates of accurate staging. Also, more liberal use of endoscopic mucosal resection will potentially improve staging in early esophageal cancer. Further evaluation of the under-staged group in this review is needed to determine if unrecognized nodal disease by preoperative staging workup in early stage esophageal cancer affects long-term survival or disease-free interval.