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Foley KG, Franklin J, Jones CM, Coles B, Roberts SA, Underwood TJ, Crosby T. The impact of endoscopic ultrasound on the management and outcome of patients with oesophageal cancer: an update of a systematic review. Clin Radiol 2022; 77:e346-e355. [PMID: 35289292 DOI: 10.1016/j.crad.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
AIM To provide an updated systematic review concerning the impact of endoscopic ultrasound (EUS) in the modern era of oesophageal cancer staging. MATERIALS AND METHODS To update the previous systematic review, databases including MEDLINE and EMBASE were searched and studies published from 2005 onwards were selected. Studies reporting primary data in patients with oesophageal or gastro-oesophageal junction cancer who underwent radiological staging and treatment, regardless of intent, were included. The primary outcome was the reported change in management after EUS. Secondary outcomes were recurrence rate and overall survival. Two reviewers extracted data from included articles. This study was registered with PROSPERO (CRD42021231852). RESULTS Eighteen studies with 11,836 patients were included comprising 2,805 patients (23.7%) who underwent EUS compared to 9,031 (76.3%) without EUS examination. Reported change of management varied widely from 0% to 56%. When used, EUS fine-needle aspiration precluded curative treatment in 37.5%-71.4%. Overall survival improvements ranged between 121 and 639 days following EUS intervention compared to patients without EUS. Smaller effect sizes were observed in a randomised controlled trial, compared to larger differences reported in observational studies. CONCLUSION Current evidence for the effectiveness of EUS in oesophageal cancer pathways is conflicting and of limited quality. In particular, the extent to which EUS adds value to contemporary cross-sectional imaging techniques is unclear and requires formal re-evaluation.
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Affiliation(s)
- K G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK; Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK.
| | - J Franklin
- Institute of Medical Imaging and Visualisation, Bournemouth University, UK
| | - C M Jones
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Coles
- Velindre University NHS Trust Library & Knowledge Service, Cardiff University, UK
| | - S A Roberts
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - T J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - T Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
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Klamt AL, Neyeloff JL, Santos LM, Mazzini GDS, Campos VJ, Gurski RR. Echoendoscopy in Preoperative Evaluation of Esophageal Adenocarcinoma and Gastroesophageal Junction: Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1657-1669. [PMID: 33896677 DOI: 10.1016/j.ultrasmedbio.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Esophageal adenocarcinomas of the esophagus and esophagogastric junction constitute a global health problem, the incidence of which has increased in recent decades. It has a poor prognosis and a low 5-year survival rate. Its treatment is based on preoperative clinical staging, in which echoendoscopy plays an essential role. The aim of this study was to evaluate the current accuracy of echoendoscopy in the staging of esophageal and esophogogastric junction adenocarcinomas. A systematic review was performed in PubMed, Embase and Portal BVS using the search terms Esophageal Neoplasm, Esophagus Neoplasms, Esophagus Cancers, Esophageal Cancers, EUS, EUS-FNA, Endoscopic Ultrasonography, Echo Endoscopy, Endosonographies and Endoscopic Ultrasound, with subsequent meta-analysis of the data found. The accuracy of tumor (T) staging was 65.55%. For T1, sensitivity was 64.7%, and specificity 89.1%, with an accuracy of 89.6%. For T2, sensitivity and specificity were 35.7% and 89.2%, respectively, with an accuracy of 87.1%. For T3, sensitivity and specificity were 82.5% and 83%, respectively, with an accuracy of 87%. For T4, sensitivity and specificity were 38.6% and 94%, respectively, with an accuracy of 66.4%. For node (N) staging, sensitivity was 77.3% and specificity 67.4%, with an accuracy of 77.9%. Echoendoscopy exhibits suboptimal accuracy in preoperative staging of esophageal adenocarcinoma and esophagogastric junction.
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Affiliation(s)
- Alexandre Luis Klamt
- Gastroenterology Service of the Hospital de Clínicas de Porto Alegre (HCPA), Graduate Program in Medicine: Surgical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil.
| | - Jeruza Lavanholi Neyeloff
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Letícia Maffazzioli Santos
- Radiology Service of the Hospital de Clínicas de Porto Alegre (HCPA), Graduate Program in Medicine: Surgical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Guilherme da Silva Mazzini
- Digestive Tract Surgery Service of the Hospital de Clínicas de Porto Alegre (HCPA), Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Vinicius Jardim Campos
- Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Richard Ricachenevsky Gurski
- Digestive Tract Surgery Service and Surgery Group of the Esophagus and Stomach of the Hospital de Clínicas de Porto Alegre (HCPA), Port Alegre, Rio Grande do Sul, Brazil; Department of Surgery, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
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Scholer AJ, Uppal A, Chang SC, Ghosh D, Garland-Kledzik M, Santamaria-Barria J, Khader A, Dehal A, Fischer T, Goldfarb M. Inaccurate pretreatment staging can impact survival in early stage esophageal adenocarcinoma. J Surg Oncol 2020; 122:914-922. [PMID: 32632944 DOI: 10.1002/jso.26101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Given the survival advantage of neoadjuvant treatment for locally advanced esophageal cancer, accurate clinical staging is necessary. The aim of this study was to assess the clinical (c) and pathologic (p) staging concordance rates for presumably early stage esophageal adenocarcinoma patients that had upfront esophagectomy (UFE) and evaluate if survival (OS) was negatively affected by inaccurate preoperative staging and subsequent treatment selection. METHODS An NCDB retrospective review of nonmetastatic esophageal adenocarcinoma patients that had UFE. The rates of concordance between c and p staging system and OS were calculated. RESULTS Of 2775 patients, most patients presented with cN0 (82.8%) and cT1 tumors (53.6%). The overall concordance between c and p staging was 78.8% for T-classification (moderate agreement; weighted κ = 0.729; P < .001) and 78.8% for N-classification (weak agreement; weighted κ = 0.448; P < .001). Patients that were upstaged due to a lack of concordance between T-classification had decreased 5- and 10-year OS (30% and 16%, P < .001) and those upstaged due to discordant N-classification had decreased 5- and 10-year OS (28% and 23%, P < .001)." CONCLUSIONS Preoperative staging of esophageal adenocarcinoma has moderate reliability and accuracy for predicting pT and pN classification. Up to 25% of patients have discordant clinical and pathological staging, which impacts OS.
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Affiliation(s)
- Anthony J Scholer
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Abhineet Uppal
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Shu-Ching Chang
- Medical Data Research Center, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon
| | - Debopriya Ghosh
- Rutgers Institute of Data Science, Learning, and Applications, Rutgers University, Newark, New Jersey
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | | | - Adam Khader
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Ahmed Dehal
- Department of Surgery, Kaiser Permanente Southern California, Pasadena, California
| | - Trevan Fischer
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Melanie Goldfarb
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
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James PD, Hegagi M, Antonova L, Tinmouth J, Heitman SJ, Simone C, Yeung E, Yong E. Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study. CMAJ Open 2017; 5:E437-E443. [PMID: 28600449 PMCID: PMC5498178 DOI: 10.9778/cmajo.20160153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. METHODS We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. RESULTS We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas. INTERPRETATION Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs- and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province.
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Affiliation(s)
- Paul D James
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Mae Hegagi
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Lilia Antonova
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Jill Tinmouth
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Steven J Heitman
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Carmine Simone
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yeung
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yong
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
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