Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer
Author Department
Internal Medicine; Medicine
Document Type
Article, Peer-reviewed
Publication Date
6-2023
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.
Keywords: Cancer intervention; Endoscopic indicators of invasive cancer; Endoscopic intervention; Endoscopic ultrasound; Endoscopy; Esophageal early-stage cancer.
Recommended Citation
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 Jun 16;15(6):447-457. doi: 10.4253/wjge.v15.i6.447.
PMID
37397975