Background: With the advent of stage-adapted multimodal regimens for many gastrointestinal malignancies, accurate staging has become of utmost importance. In esophageal cancer, endoscopic ultrasonography (EUS) emerged as standard to determine T and N stage. Objective: Since growth patterns of squamous carcinoma (SC) differs from adenocarcinoma (AC) and lymph nodes are located at various distances from the esophagus in a horizontal plane, we studied the accuracy of esophageal EUS as a function of tumor type and localization of the tumor within the esophagus. Results: Overall staging accuracy was 79% for T and for N staging. Staging was more accurate for T3/4, when compared to T1/2 tumors, and for SC when compared to AC. Histological T1/2 stages were overstaged by EUS in 8/17 patients, mostly in patients with AC (6/10). The sensitivity of retrosternal pain and of dysphagia for extramural disease was 57 and 92% respectively, the specificity of pain for extramural disease was 73%, and of dysphagia 36%. Preoperative weight loss in this series correlated linearly with tumor stages. Conclusions: The accurate preoperative staging of T2 esophageal endodermal malignancies is crucial for treatment stratification but difficult to achieve by visual analysis of endosonography alone. Postacquisition processing of echoendosonographic images might further increase the accuracy of echoendosonography and aid in the critical differentiation of T2 versus T3 esophageal malignancies. Preoperative weight loss and retrosternal pain are good clinical indicators of extramural disease.
Martin K. Schilling, MD
Department of Visceral and Transplantation Surgery
University of Bern, Inselspital
CH–3010 Bern (Switzerland)
Tel. +41 31 632 2117, Fax +41 31 632 9723, E-Mail firstname.lastname@example.org
Received: Received: August 5, 1999
Accepted: December 13, 1999
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 4, Number of References : 45
Digestive Surgery (Official Journal of Collegium Internationale Chirurgiae Digestivae (CICD); Official Journal of European Digestive Surgery (EDS))
Vol. 17, No. 3, Year 2000 (Cover Date: 2000)
Journal Editor: M.W. Büchler, Bern; E.H. Farthmann, Freiburg i.Br.
ISSN: 0253–4886 (print), 1421–9983 (Online)
For additional information: http://www.karger.com/journals/dsu
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