Kalha Ishaan, Kaw Madhukar, Fukami Norio, Patel Mihir, Singh Sandeep, Gagneja Harish, Cohen Deborah, Morris Jeffrey
Department of Gastrointestinal Medicine/Nutrition, The University of Texas MD Anderson Cancer Center, Houston 77082, USA.
Cancer. 2004 Sep 1;101(5):940-7. doi: 10.1002/cncr.20429.
Endoscopic ultrasound (EUS) is an accurate staging modality for esophageal malignancy. Studies have determined that EUS does not retain this accuracy after chemoradiation and that it should not be used as a restaging tool for esophageal carcinoma. In this study, the authors examined their experience with esophageal carcinoma and restaging after neoadjuvant therapy with EUS.
A retrospective chart review was conducted that included 83 patients with locoregional esophageal adenocarcinoma who were treated with chemoradiation under protocol. All patients underwent surgical resection. EUS was performed for restaging, and the results were compared with findings at surgical pathology using the TNM classification system.
All 83 patients identified underwent surgery. There were 77 males, and the mean patient age was 59 years. At restaging, the tumor status (T classification) was assessed correctly by EUS in 22 of 83 patients (29%). The sensitivity of EUS for the individual T classifications were 0% for T0 tumors, 19% for T1 tumors, 27% for T2 tumors, 52% for T3 tumors, and 0% for T4 tumors. In 19 of 83 patients, the tumor classification was correct, whereas 42 of 83 patients were over classified, and 15 of 83 patients were under classified when the EUS results were compared with the surgical pathology results. The lymph node status (N classification) was assessed correctly by EUS in 41 of 83 patients. The sensitivity of EUS for N classification was 48% for N0 disease and 52% for N1 disease. Twenty-two patients were restaged with residual disease according to the EUS results but had no evidence of residual tumor or lymph node involvement according to the surgical pathology results.
EUS did not retain its usefulness as a restaging modality after neoadjuvant chemoradiation for esophageal adenocarcinoma when the standard TNM classification system was used.
内镜超声（EUS）是一种用于食管癌的准确分期方法。研究已确定，放化疗后EUS不再保持这种准确性，且不应将其用作食管癌的再分期工具。在本研究中，作者考察了他们在食管癌及新辅助治疗后使用EUS进行再分期的经验。
进行了一项回顾性病历审查，纳入83例接受放化疗方案治疗的局部区域性食管腺癌患者。所有患者均接受了手术切除。进行EUS以进行再分期，并使用TNM分类系统将结果与手术病理结果进行比较。
所有83例确诊患者均接受了手术。其中男性77例，患者平均年龄为59岁。在再分期时，83例患者中有22例（29%）通过EUS正确评估了肿瘤状态（T分类）。EUS对各T分类的敏感性分别为：T0肿瘤为0%，T1肿瘤为19%，T2肿瘤为27%，T3肿瘤为52%，T4肿瘤为0%。将EUS结果与手术病理结果进行比较时，83例患者中有19例肿瘤分类正确，83例患者中有42例分类过高，83例患者中有15例分类过低。83例患者中有41例通过EUS正确评估了淋巴结状态（N分类）。EUS对N分类的敏感性为：N0疾病为48%，N1疾病为52%。根据EUS结果，22例患者被重新分期为有残留疾病，但根据手术病理结果，并无残留肿瘤或淋巴结受累的证据。
当使用标准TNM分类系统时，EUS在食管腺癌新辅助放化疗后作为再分期方法已不再有用。
