Laterza E, de Manzoni G, Guglielmi A, Rodella L, Tedesco P, Cordiano C
First Division of General Surgery, University of Verona, Italy.
Ann Thorac Surg. 1999 May;67(5):1466-9. doi: 10.1016/s0003-4975(99)00267-2.
In past years multimodal neoadjuvant treatment for carcinoma of the esophagus has been used with increased frequency. Staging of the neoplasm still remains fundamental in evaluating the response to therapy and in planning operation. The aim of the present study was to assess the accuracy of endoscopic ultrasonography (EUS) in a group of patients with squamous cell carcinoma of the thoracic esophagus after undergoing radiotherapy and chemotherapy.
Among a group of 111 patients with squamous cell carcinoma of the thoracic esophagus and treated with preoperative radiotherapy and chemotherapy, 87 were operated. In these patients it was possible to compare the results of EUS, with regard to depth of invasion of esophageal wall (T) and lymph node involvement (N), with the results of operation and histopathologic study.
Feasibility of EUS before and after neoadjuvant treatment was 71.2% and 83.9%, respectively. The overall accuracy of EUS regarding the wall invasion was 47.9%. The more frequent error was overstaging, especially in patients with complete response and in patients with minimal residual disease. In the assessment of lymph node involvement, EUS showed an overall accuracy of 71.2% with a moderate kappa value. Sensitivity for N1 and NO was 73.7% and 68.6%, respectively.
Endoscopic ultrasonography was feasible in most patients after preoperative radiotherapy and chemotherapy, but our study documented a worsening of accuracy of EUS in the evaluation of T attributable to the confounding presence of radiation fibrosis and soft tissue reaction after radiotherapy and chemotherapy.
在过去几年中，食管癌的多模式新辅助治疗使用频率有所增加。肿瘤分期在评估治疗反应和规划手术方面仍然至关重要。本研究的目的是评估内镜超声检查（EUS）在一组接受放疗和化疗后的胸段食管鳞状细胞癌患者中的准确性。
在一组111例接受术前放疗和化疗的胸段食管鳞状细胞癌患者中，87例接受了手术。在这些患者中，可以将EUS在食管壁浸润深度（T）和淋巴结受累（N）方面的结果与手术和组织病理学研究结果进行比较。
新辅助治疗前后EUS的可行性分别为71.2%和83.9%。EUS在评估壁浸润方面的总体准确率为47.9%。最常见的错误是过度分期，尤其是在完全缓解的患者和残留疾病极少的患者中。在评估淋巴结受累方面，EUS的总体准确率为71.2%，kappa值中等。对N1和N0的敏感性分别为73.7%和68.6%。
内镜超声检查在大多数术前放疗和化疗后的患者中是可行的，但我们的研究记录了由于放疗和化疗后放射性纤维化和软组织反应的混杂存在，EUS在评估T时的准确性有所下降。
