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Molina JC, Goudie E, Pollock C, Menezes V, Ferraro P, Lafontaine E, Martin J, Nasir B, Liberman M. Balloon Dilation for Endosonographic Staging in Esophageal Cancer: A Phase 1 Clinical Trial. Ann Thorac Surg 2020; 111:1150-1155. [PMID: 32866480 DOI: 10.1016/j.athoracsur.2020.06.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/26/2020] [Accepted: 06/15/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dilation in patients with malignant esophageal strictures precluding the passage of the endoscopic ultrasonography (EUS) scope allows complete evaluation; however, it may be associated with complications. This study evaluates the safety and clinical value of balloon dilation to complete EUS in patients with stenotic esophageal cancers. METHODS This study consists of a phase I clinical trial. One-hundred-and fifty patients were recruited. Endoscopic balloon dilation was performed before EUS in patients with high-grade stenosis. The analysis was focused on the ability to complete an endosonographic examination after dilation, 30-day morbidity, and change in the final stage or definitive management based on the completed endosonographic examination. RESULTS Dilation was required in 55 patients (36.7%), with a complication rate of 10.9% (n = 6). Dilation allowed completion of EUS in 53 patients (96.4%), leading to a modification of the clinical stage for 18 patients (34%) and a deviation in the treatment plan in 7 patients (13.2%). No differences were found in these variables when compared with the group that did not require dilation (26.3% and 14.7%, P = .33 and P = .79, respectively). Dilation was associated with more advanced disease on final pathology among patients who underwent surgical resection (P = .006). CONCLUSIONS High-grade malignant esophageal strictures that preclude the passage of the ultrasound probe are associated with advanced stage disease. Owing to the high risk of perforation and the limited benefit in staging, balloon dilation to complete the EUS staging should be avoided. (Clinicaltrials.gov identifier: NCT01950442.).
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Affiliation(s)
- Juan Carlos Molina
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Eric Goudie
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Clare Pollock
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Vanessa Menezes
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Edwin Lafontaine
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Jocelyne Martin
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Basil Nasir
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Esophageal Center, Montreal University Hospital Center, Montreal, Quebec, Canada.
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Thakkar S, Kaul V. Endoscopic Ultrasound Stagingof Esophageal Cancer. Gastroenterol Hepatol (N Y) 2020; 16:14-20. [PMID: 33867884 PMCID: PMC8040903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Esophageal cancer has increased in incidence over the last several decades and is now the sixth leading cause of all cancer deaths, with more than 500,000 deaths in 2018. The 2 most common types of esophageal cancer, squamous cell cancer and esophageal adenocarcinoma, make up nearly 95% of diagnoses. Based on the global distribution of these histologic types, esophageal adenocarcinoma is more common in the United States while squamous cell cancer is more common throughout the world. For both the squamous cell cancer and esophageal adenocarcinoma variants of esophageal cancer, the most important step in determining prognosis and survival is accurate staging. Endoscopy, computed tomography, whole-body positron emission tomography with 18-fluorodeoxyglucose, and endoscopic ultrasound (EUS) all have important roles in the diagnosis and staging of esophageal cancer. EUS is key for locoregional staging and guides treatment planning of esophageal cancer in the absence of distant metastases. EUS has been shown to improve survival across various stages of esophageal cancer and to have a positive financial impact in cost-effectiveness analyses. This article describes current EUS technology and the role of EUS in esophageal cancer staging, as well as the applications, challenges, and limitations of EUS in the management of this disease.
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Affiliation(s)
- Shyam Thakkar
- Dr Thakkar is the chief of endoscopy and a clinical associate professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition and the Center for Advanced Endos-copy in the Allegheny Health Network in Pittsburgh, Pennsylvania. Dr Kaul is the Segal-Watson Professor of Medicine in the Division of Gastroenterology & Hepatology and the Center for Advanced Therapeutic Endoscopy at the University of Rochester Medical Center in Rochester, New York
| | - Vivek Kaul
- Dr Thakkar is the chief of endoscopy and a clinical associate professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition and the Center for Advanced Endos-copy in the Allegheny Health Network in Pittsburgh, Pennsylvania. Dr Kaul is the Segal-Watson Professor of Medicine in the Division of Gastroenterology & Hepatology and the Center for Advanced Therapeutic Endoscopy at the University of Rochester Medical Center in Rochester, New York
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Shi H, Ma S, Zhao P, Jiang J, Cheng Y, Zhao J, Wang J, Qiao Z, Jiang J, Li S, Wu J. Endoscopic ultrasonography for preoperative staging of esophageal carcinoma. Scand J Gastroenterol 2017. [PMID: 28625089 DOI: 10.1080/00365521.2017.1339829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative staging of esophageal carcinoma (EC). MATERIAL AND METHODS A total of 86 surgical patients with EC who were confirmed by endoscopy and biopsy underwent preoperative TN staging with EUS examination. The EUS findings were compared with surgical pathologic results. RESULTS The accuracy of EUS in T and N staging of EC was 82.6% and 84.9%, respectively. While determining whether EC invades the muscularis propria or outer membrane, EUS had the favorable sensitivity, specificity, positive predictive value and negative predictive value. The short-axis diameter of lymph nodes of 5mm had high sensitivity and negative predictive value to determine malignance with low specificity and positive predictive value. The short-axis diameter of 10mm presented the satisfactory sensitivity, specificity, positive predictive value and negative predictive value. CONCLUSION EUS can accurately determine the TN staging of EC and provide a reliable basis for the treatment of EC.
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Affiliation(s)
- Haitao Shi
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Shiyang Ma
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Ping Zhao
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jiong Jiang
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Yan Cheng
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Juhui Zhao
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jinhai Wang
- a Department of Gastroenterology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Zhe Qiao
- b Department of Thoracic Surgery , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jiantao Jiang
- b Department of Thoracic Surgery , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Shaomin Li
- b Department of Thoracic Surgery , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jie Wu
- c Department of Pathology , The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
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Mansfield SA, El-Dika S, Krishna SG, Perry KA, Walker JP. Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions. Surg Endosc 2016; 31:3227-3233. [PMID: 27864719 DOI: 10.1007/s00464-016-5351-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) has been routinely utilized for the locoregional staging of esophageal cancer. One important aspect of clinical staging has been to stratify patients to treatment with neoadjuvant chemoradiation or primary surgical therapy. We hypothesized that EUS may have a limited impact on clinical decision making in patients with dysphagia and obstructing esophageal masses. METHODS This retrospective cohort study included all patients with esophageal adenocarcinoma undergoing esophageal EUS between July 2008 and September 2013. Dysplastic Barrett's esophagus without invasive adenocarcinoma or incomplete staging was excluded. Patient demographics, endoscopic tumor characteristics, the presence of dysphagia, sonographic staging, and post-EUS therapy were recorded. Pathologic staging for patients who underwent primary surgical therapy was also recorded. Locally advanced disease was defined as at least T3 or N1, as these patients are typically treated with neoadjuvant therapy. RESULTS Two hundred sixteen patients underwent EUS for esophageal adenocarcinoma, with 147 (68.1%) patients having symptoms of dysphagia on initial presentation. Patients with dysphagia were significantly more likely to have locally advanced disease on EUS than patients without dysphagia (p < 0.0001). Additionally, 145 (67.1%) patients had a partially or completely obstructing mass on initial endoscopy, of which 136 (93.8%) were locally advanced (p < 0.0001 vs. non-obstructing lesions). CONCLUSIONS An overwhelming majority of patients presenting with dysphagia and/or the presence of at least partially obstructing esophageal mass at the time of esophageal cancer diagnosis had an EUS that demonstrated at least locally advanced disease. The present study supports the hypothesis that EUS may be of limited benefit for management of esophageal cancer in patients with an obstructing mass and dysphagia.
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Affiliation(s)
- Sara A Mansfield
- General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samer El-Dika
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Somashekar G Krishna
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Kyle A Perry
- General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jon P Walker
- Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA.
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Abstract
In the esophagus two different kinds of primary neoplasias may arise: squamocellular carcinomas (SCC) and esophageal adenocarcinomas (EAC). Although both types of carcinoma are rare diseases, especially the incidence of EAC rose in the last years. The management of esophageal cancer is challenging. There are no specific symptoms of early esophageal cancers. Due to this fact, most of the esophageal cancers are found incidentally, and only 12.5% of esophageal tumors are endoscopically resectable. Gastroscopy is the gold standard for the diagnosis of esophageal cancer. The sensitivity of detecting early-stage carcinoma may be improved by adjunct techniques such as chromoendoscopy, virtual chromoendoscopy, magnification endoscopy, and other advanced endoscopic imaging techniques. The diagnosis of esophageal cancer can be verified with targeted biopsies. Accurate staging information is crucial for establishing appropriate treatment choices for esophageal cancer, while the depth of the tumor determines the feasibility of therapy. In terms of staging, endosonography, abdominal ultrasound, and computed tomography scan of the thorax and abdomen should thus be performed before initiation of therapy.
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Affiliation(s)
- Volker Meves
- Internal Medicine, Vivantes Klinikum im Friedrichshain, University Teaching Hospital of the Humboldt University Berlin (Charité), Berlin, Germany
| | - Angelika Behrens
- Internal Medicine, Vivantes Klinikum im Friedrichshain, University Teaching Hospital of the Humboldt University Berlin (Charité), Berlin, Germany
| | - Jürgen Pohl
- Internal Medicine, Vivantes Klinikum im Friedrichshain, University Teaching Hospital of the Humboldt University Berlin (Charité), Berlin, Germany
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Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jue TL, Pasha SF, Sharaf R, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2013; 77:328-34. [PMID: 23410694 DOI: 10.1016/j.gie.2012.10.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 02/08/2023]
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Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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8
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Dilation of malignant strictures in endoscopic ultrasound staging of esophageal cancer and metastatic spread of disease. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:356538. [PMID: 22203779 PMCID: PMC3235661 DOI: 10.1155/2011/356538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/30/2011] [Accepted: 10/04/2011] [Indexed: 12/15/2022]
Abstract
Background. Dilation of malignant strictures in endoscopic ultrasound (EUS) staging of esophageal cancer is safe, but no data exists regarding the subsequent development of metastases. Aim. Compare the rates of metastases in esophageal cancer patients undergoing EUS staging who require esophageal dilation in order to pass the echoendoscope versus those who do not. Methods. We reviewed consecutive patients referred for EUS staging of esophageal cancer. We evaluated whether dilation was necessary in order to pass the echoendoscope, and for the subsequent development of metastases after EUS at various time intervals. Results. Among all patients with similar stage (locally advanced disease, defined as T3, N0, M0 or T1-3, N1, M0), there was no difference between the dilated and nondilated groups in the rates of metastases at 3 months (14% versus 10%), P = 1.0, 6 months (28% versus 20%), P = 0.69, 12 months (43% versus 40%), P = 1.0, or ever during a mean followup of 15 months (71% versus 55%), P = 0.48. Conclusions. Dilation of malignant strictures for EUS staging of esophageal cancer does not appear to lead to higher rates of distant metastases.
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9
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Buxbaum JL, Eloubeidi MA. Transgastric endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with esophageal narrowing using the ultrasonic bronchovideoscope. Dis Esophagus 2011; 24:458-61. [PMID: 21385282 DOI: 10.1111/j.1442-2050.2011.01179.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is emerging as a critical technology in the evaluation of mediastinal lesions and is increasingly regarded as complementary to endoscopic ultrasound (EUS) in this arena. This complementary role may extend into the abdomen in cases where esophageal strictures prevent the passage of the echoendoscope. The objective of the study was to characterize the uses of EBUS-FNA in the evaluation of gastrointestinal lesions in patients with esophageal narrowing. The study design was a single-center case series. The setting was in a tertiary referral center. Four patients underwent EBUS-FNA to evaluate gastrointestinal lesions; esophageal strictures prevented EUS passage in three, the fourth patient did not tolerate transbronchial EBUS but had abdominal lesions within reach of the EBUS scope. EBUS was used to evaluate the liver, adrenal gland, a retroperitoneal mass, and a celiac axis lymph node. EBUS-FNA has greater potential to evaluate abdominal lesions than has been previously recognized. The EBUS scope represents a safe and readily available technology to evaluate patients with esophageal strictures. Interventional endoscopists should be exposed to this modality.
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Affiliation(s)
- J L Buxbaum
- Division of Gastroenterology, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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10
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Polkowski M. Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23:649-61. [PMID: 19744630 DOI: 10.1016/j.bpg.2009.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 05/26/2009] [Indexed: 02/07/2023]
Abstract
Numerous studies conducted over the last 25 years provide evidence on the high diagnostic accuracy and important role of endoscopic ultrasonography (EUS) in staging oesophageal and gastric carcinoma. This extensive research was recently subjected to metaanalyses, condensing our knowledge on EUS performance and facilitating its comparison with competing methods. It is, however, important to realise that the management of oesophageal and gastric carcinoma is evolving and so are staging algorithms, setting new challenges for EUS and re-defining its position. Restaging after neoadjuvant treatment and precise assessment of early carcinoma before endoscopic treatment are areas of growing interest, but the role of EUS in these settings is rather limited. Rapidly developing cross-sectional imaging has the potential to challenge the position of EUS as the most accurate method in loco-regional staging. On the other hand, EUS guided fine-needle aspiration offers the unique opportunity to obtain cytological confirmation of lymph node metastases, with future potential for molecular staging.
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Affiliation(s)
- M Polkowski
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland.
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Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer. Gastrointest Endosc 2009; 69:1210-7. [PMID: 19012886 DOI: 10.1016/j.gie.2008.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 08/07/2008] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although EUS-guided FNA (EUS-FNA) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) are both used in the staging of esophageal cancer, the utility of routinely performing both tests is unclear. OBJECTIVES The primary aim of the study was to determine the benefit of routine FDG-PET for esophageal cancer nodal staging in patients undergoing EUS-FNA. The secondary objective was to determine EUS criteria that selectively identify patients in whom PET yields additional information. DESIGN Retrospective chart review. SETTING Tertiary-care academic medical center. PATIENTS AND INTERVENTIONS All patients who underwent both EUS and PET for initial staging of esophageal cancer between April 2003 and August 2007. MAIN OUTCOME MEASUREMENTS EUS and PET detection of malignant lymph nodes and distant metastases. RESULTS Of 242 patients who underwent esophageal EUS for a malignant indication, 148 also underwent PET within 30 days. EUS detected locoregional-node disease by EUS criteria or cytology in 92 patients, and PET was positive in a minority of these patients (n = 41 [45%]). For celiac-node staging, PET was positive in 2 of 17 patients (12%) with celiac-node involvement detected by EUS. EUS was also significantly more sensitive than PET in the detection of nodal disease confirmed by cytology or histology (86% vs 44%). PET did not alter nodal staging in any patient with complete EUS-FNA. PET identified distant metastases only in those patients with incomplete EUS or nodal disease detected by EUS. LIMITATIONS Single institution, retrospective analysis. CONCLUSIONS The addition of PET to a complete EUS examination did not alter regional-node or celiac-node staging. PET performance in overall staging is strongly associated with EUS assessment of lymph nodes.
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Abstract
Esophageal malignancy is a major source of morbidity and mortality, despite the recently increased attention to screening and early detection. Prognosis for esophageal cancer remains grim, with advanced tumor stage and lymph node metastases conferring even graver outcomes. Several studies have demonstrated that the addition of preoperative neoadjuvant chemoradiotherapy may improve survival in patients with locally advanced tumor (T3) disease or local lymph node metastases. It is here that endoscopic ultrasonography finds its niche in the precise staging of these tumors and the subsequent use of stage-dependent treatment protocols.
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Affiliation(s)
- Alan Brijbassie
- Carilion Clinic, 3113-G Honeywood Lane, Roanoke, VA 24018, USA
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Di Franco F, Lamb PJ, Karat D, Hayes N, Griffin SM. Iatrogenic perforation of localized oesophageal cancer. Br J Surg 2008; 95:837-9. [DOI: 10.1002/bjs.6055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A plea not to dilate
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Affiliation(s)
- F Di Franco
- Department of Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - P J Lamb
- Department of Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - D Karat
- Department of Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - N Hayes
- Department of Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - S M Griffin
- Department of Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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