Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer

Table 1 Basic demographics and clinical characteristics of all patients

Variable		Number/Total (n/N)	Percentage (%)
Gender	Males	42/49	85.7
Ethnicity	Caucasian	42/48	87.5
	Hispanic	1/48	2.1
	Asian	5/48	10.4
Type of cancer	Adenocarcinoma	44/49	89.8
	SCC	5/49	10.2
Degree of differentiation	Invasive well differentiated	18/39	46.2
	Invasive moderately differentiated	19/39	48.7
	Invasive poorly differentiated	4/39	10.3
History of Barrett’s esophagus	Yes	32/49	65.3
Esophageal ulceration	Yes	15/49	30.6
Tumor size	< 1 cm	6/48	12.5
	1 – < 1.5 cm	12/48	25
	≥ 1.5 - < 2 cm	11/48	22.9
	≥ 2 cm	19/48	39.6
Lymphadenopathy	Yes (only non-diagnostic EUS features)	24/48	50.0
EUS stage	T1a	24/49	48.9
	T1b	10/49	20.4
	T2	4/49	8.2
	T3	11/49	22.4
	T4	0/49	0
Specimen collection method	Biopsy	4/49	8.2
	EMR	25/49	51.0
	ESD	5/49	10.2
	Esophagectomy	15/49	30.6
Lympho-vascular invasion	Yes	12/49	24.4
Pathological staging	T1a	20/49	40.8
	T1b	13/49	26.5
	T2	5/49	10.2
	T3	11/49	22.4
Tumor recurrence	Yes	5/44	11.4

n: Number of patients with demographic or clinical characteristic present; N: Number of patients with clinical data available regarding the presence or absence of each demographic or clinical characteristic. EMR: Endoscopic mucosal resection; ESD: Submucosal dissection; EUS: Endoscopic ultrasound; SCC: Squamous cell carcinoma.

Table 2 Frequencies and proportions of endoscopic ultrasound staging across pathological staging categories, n (%)

			Pathologic stage
			T1a, N = 20	T1b, N = 13	T2, N = 5	T3, N = 11
EUS stage	T1a	n/N (%)	17/20 (85.7)	6/13 (46.2)	1/5 (20)	0/11 (0)
	T1b	n/N (%)	3/20 (14.2)	6/13 (46.2)	1/5 (20)	0/11 (0)
	T2	n/N (%)	0/20 (0)	1/13 (7.7)	3/5 (60)	0/11 (0)
	T3	n/N (%)	0/20 (0)	0/13 (0)	0/5 (0)	11/11 (100)

EUS: Endoscopic ultrasound.

Table 3 Sensitivity, specificity and diagnostic accuracy of endoscopic ultrasound staging in identifying submucosal invasion (T1b) in T1 cancers

		Submucosal invasion on path
		Yes (T1b), N = 13	No (T1a), N = 20	Sensitivity	Specificity	PPV	NPV	Accuracy
Submucosal invasion on EUS	Yes	7	3	53.9%	85.0%	70%	73.9%	72.7%
	No	6	17

EUS: Endoscopic ultrasound.

Table 4 Proportions of patients with deep invasion (T2 and beyond) having the significant endoscopic or pathologic parameter compared to proportions of patients without deep invasion

Deep invasion on pathology		Endoscopic parameter
		Tumor size ≥ 2 cm on visual inspection	Presence of esophageal ulceration	Tumor size ≥ 2 cm on visual inspection & presence of esophageal ulceration
Yes (T2 and beyond)	n1/N1 (%)	13/16 (81.2)	8/16 (50.0)	7/16 (43.8)
No (T1a and T1b)	n2/N2 (%)	6/32 (18.8)	7/33 (21.2)	2/33 (6.1)
P valuea		< 0.001	0.0403	0.0014
Deep invasion on pathology		Degree of differentiation on pathology
		Well-Differentiated	Moderately to poorly differentiated
Yes (T2 and beyond)	n1/N1 (%)	2/12 (16.7)	10/12 (83.3)
No (T1a and T1b)	n2/N2 (%)	14/27 (53.6)	13/27 (46.4)
P valuea		0.0392	0.0392

^aP value derived from chi-square test to compare proportions in each column for patients with deep invasion (“Yes” row) for each endoscopic or pathologic parameter and without deep invasion (“No” row).

n₁: Number of patients with factor being assessed and deep invasion on pathology; N₁: Number of patients with deep invasion on pathology and clinical data available regarding the presence or absence of each factor; n₂: Number of patients with factor being assessed and no deep invasion on pathology; N₂: Number of patients without deep invasion on pathology and clinical data available regarding the presence or absence of each factor.

Table 5 Proportions of patients with deep invasion (T2 and beyond) having the endoscopic ultrasound parameters assessed compared to proportions of patients without deep invasion

Deep invasion on pathology		EUS parameter
		Presence of notable (but non-diagnostic) para-esophageal lymph nodes on EUS	Presence of positive lymph nodes by EUS criteria
Yes (T2 and beyond)	n1/N1 (%)	13/16 (81.2)	0/16 (0)
No (T1a and T1b)	n2/N2 (%)	11/33 (33.3)	0/33 (0)
P valuea		< 0.001	N/A

^aP value derived from chi-square test done to compare proportion of patients with deep invasion for each endoscopic or pathologic parameter (“Yes” row) to proportion of patients without deep invasion (“No” row).

n₁: Number of patients with factor being assessed AND deep invasion on pathology; n₂: Number of patients with factor being assessed AND no deep invasion on pathology; N₁: Number of patients with deep invasion on pathology and clinical data available regarding the presence or absence of each factor; N₂: Number of patients without deep invasion on pathology and clinical data available regarding the presence or absence of each factor. EUS: Endoscopic ultrasound; N/A: Not applicable.

Table 6 Cases of endoscopic ultrasound concordance and discordance with endoscopic parameters suggesting superficial cancer

Endoscopic Parameter(s) Associated with superficial cancer	Cases of EUS revealing superficial cancer (leading to EMR or ESD)	Cases of EUS revealing DI (Esophagectomy performed)	Frequency EUS changes management (%)
Tumor size < 2 cm	27	2	6.9
Lack of ulceration	26	8	23.5
Tumor size < 2 cm & lack of ulceration	20	1	4.8

EUS: Endoscopic ultrasound; ESD: Submucosal dissection; EMR: Endoscopic mucosal resection; DI: Deep invasion.