Kahlon S, Aamar A, Butt Z, Urayama S. Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer. World J Gastrointest Endosc 2023; 15(6): 447-457 [PMID: 37397975 DOI: 10.4253/wjge.v15.i6.447]
Corresponding Author of This Article
Shiro Urayama, MD, Professor, Department of Internal Medicine, University of California-Davis, 4150 V St Suite 3500, Sacramento, CA 95817, United States. surayama@ucdavis.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastrointest Endosc. Jun 16, 2023; 15(6): 447-457 Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.447
Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer
Sartajdeep Kahlon, Ali Aamar, Zeeshan Butt, Shiro Urayama
Sartajdeep Kahlon, Ali Aamar, Shiro Urayama, Department of Internal Medicine, University of California-Davis, Sacramento, CA 95817, United States
Zeeshan Butt, Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, United States
Author contributions: Kahlon S, Aamar A, and Urayama S designed the research study; Kahlon S and Aamar A performed the research; Kahlon S and Butt Z conducted the statistical analysis; Kahlon S and Urayama S analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the UC Davis Institutional Review Board [(Approval No. 1816393-1]).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained from electronic medical record. A HIPPA waiver was provided by institutional IRB.
Conflict-of-interest statement: Shiro Urayama, MD has financial relationships with the following entities: Olympus America Inc., Noah Medical. Neither entity is directly involved in this work and no financial and/or material support was received for this research or the creation of this work. All other authors have no relationships relevant to the contents of this paper to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sakahlon@ucdavis.edu. Participants consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shiro Urayama, MD, Professor, Department of Internal Medicine, University of California-Davis, 4150 V St Suite 3500, Sacramento, CA 95817, United States. surayama@ucdavis.edu
Received: February 24, 2023 Peer-review started: February 24, 2023 First decision: March 24, 2023 Revised: April 8, 2023 Accepted: May 12, 2023 Article in press: May 12, 2023 Published online: June 16, 2023 Processing time: 110 Days and 5.2 Hours
Abstract
BACKGROUND
Endoscopic ultrasound (EUS) stands as an accurate imaging modality for esophageal cancer staging, however utilization of EUS in early-stage cancer management remains controversial. Identification of non-applicability of endoscopic interventions with deep muscular invasion with EUS in pre-intervention evaluation of early-stage esophageal cancer is compared to endoscopic and histologic indicators.
AIM
To display the role of EUS in pre-intervention early esophageal cancer staging and how the index endoscopic features of invasive esophageal malignancy compare for prediction of depth of invasion and cancer management.
METHODS
This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center from 2012 to 2022. Patient clinical data, initial esophagogastroduodenoscopy/biopsy, EUS, and final resection pathology reports were abstracted, and statistical analysis was conducted to assess the role of EUS in management decisions.
RESULTS
Forty nine patients were identified for this study. EUS T stage was concordant with histological T stage in 75.5% of patients. In determining submucosal involvement (T1a vs T1b), EUS had a specificity of 85.0%, sensitivity of 53.9%, and accuracy of 72.7%. Endoscopic features of tumor size > 2 cm and the presence of esophageal ulceration were significantly associated with deep invasion of cancer on histology. EUS affected management from endoscopic mucosal resection/submucosal dissection to esophagectomy in 23.5% of patients without esophageal ulceration and 6.9% of patients with tumor size < 2 cm. In patients without both endoscopic findings, EUS identified deeper cancer and changed management in 4.8% (1/20) of cases.
CONCLUSION
EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity. Data validated endoscopic indicators suggested superficial cancers in the group with a tumor size < 2 cm and the lack of esophageal ulceration. In patients with these findings, EUS rarely identified a deep cancer that warranted a change in management.
Core Tip: This study aims to convey the role of endoscopic ultrasound (EUS) for early esophageal cancer considered for endoscopic or surgical resection and how the index endoscopic features of esophageal malignancy compare for prediction of depth of invasion and cancer management. This was a retrospective study of 49 patients who underwent pre-resection EUS after diagnosis of esophageal cancer. EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity. Data validated endoscopic features suggesting superficial cancers including a tumor size < 2 cm and the lack of esophageal ulceration. In patients with these findings, EUS rarely identified a deep cancer that warranted a change in management.
