Giacoia A, Thomas P, Giovannini M, Hannoun-Lévy J M, Garbe L, Thirion X, Lécuyer J, Giudicelli R, Seitz J F, Fuentes P
Service de Chirurgie Thoracique et des Maladies de l'OEsophage, Hôpital Sainte-Marguerite, Marseille.
Ann Chir. 1997;51(10):1077-83.
To assess the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation.
Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated on between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all operative specimens was performed by the same pathologist, not informed about the results of EUS. Data were collected by another independent observer.
EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensitivity of EUS in detecting the depth of esophageal involvement (T0-2 vs. T3-4) were 82.3%, 78%, and 86% respectively, and 72%, 70%, and 73% respectively for lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67%, with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7 (64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor.
EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds of cases.
评估内镜超声检查（EUS）对食管癌局部和区域分期的诊断准确性，以及术前放化疗对其可能产生的影响。
对1992年1月至1995年12月间连续85例接受EUS检查并手术的食管癌患者进行前瞻性研究。其中28例患者曾接受诱导治疗。所有病例中，EUS检查由同一位不了解先前形态学检查结果的医生进行。所有手术标本的组织病理学分析由同一位不了解EUS结果的病理学家进行。数据由另一位独立观察者收集。
8例（9.5%）患者因严重狭窄导致内镜无法通过，EUS检查分期不完整。EUS检测食管受累深度（T0 - 2 vs. T3 - 4）的准确性、特异性和敏感性分别为82.3%、78%和86%，检测淋巴结转移的准确性、特异性和敏感性分别为72%、70%和73%。EUS识别术前分期的总体准确性为67%，接受诱导治疗的患者准确性有明显变化（61%对72%）。另一方面，11例内镜超声检查认为有完全缓解的患者中，7例（64%）无残留肿瘤。
EUS可为术前识别局部进展期食管肿瘤提供精确信息，即使在诱导治疗后也是如此。诱导治疗会改变EUS的诊断准确性，尽管三分之二的病例可识别出完全缓解者。
