Heeren P A, van Westreenen H L, Geersing G J, van Dullemen H M, Plukker J T
Dept. of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands.
Endoscopy. 2004 Nov;36(11):966-71. doi: 10.1055/s-2004-825956.
Endoscopic ultrasonography (EUS) is the most accurate method of assessing the locoregional extent of cancer of the esophagus and esophagogastric junction. The aim of this study was to evaluate the influence of tumor-related factors such as length and location on the accuracy of EUS in staging these tumors.
Between January 1997 and September 2002, 280 consecutive patients underwent preoperative EUS for staging cancer of the esophagus and esophagogastric junction. The influence of histopathology, the presence of Barrett's dysplasia or stenosis, and the location and length of the primary tumor on the accuracy of EUS for T, N, and M staging were studied.
The overall accuracy rates of EUS for assessing the T, N, and M stages were 73 %, 80 %, and 78 %, respectively. The influence of the tumor's histopathology and the presence of Barrett's dysplasia or stenosis was minimal. The accuracy of EUS was greater in tumors 5 cm or less in size than in tumors larger than 5 cm (82 % vs. 52 % for the T stage, P < 0.05; 88 % vs. 59 % for the N stage, P < 0.05; and 92 % vs. 56 % for the M stage, P < 0.001). The low accuracy of T staging in larger tumors may be due to the exclusion of patients with local unresectability or distant metastases. EUS was also significantly better in esophageal tumors, particularly for identifying celiac trunk metastases (93 % vs. 63 %; P < 0.001).
The accuracy of EUS for staging esophageal cancer is lower in tumors larger than 5 cm and in esophagogastric junction tumors than in tumors 5 cm in size or less and in esophageal tumors. These findings should be considered when treatment decisions are being taken.
内镜超声检查（EUS）是评估食管癌及食管胃交界部癌局部区域范围最准确的方法。本研究旨在评估肿瘤相关因素（如长度和位置）对EUS对这些肿瘤分期准确性的影响。
1997年1月至2002年9月，280例连续患者接受了术前EUS检查以对食管癌及食管胃交界部癌进行分期。研究了组织病理学、巴雷特发育异常或狭窄的存在以及原发肿瘤的位置和长度对EUS进行T、N和M分期准确性的影响。
EUS评估T、N和M期的总体准确率分别为73%、80%和78%。肿瘤组织病理学以及巴雷特发育异常或狭窄的存在影响极小。EUS对大小为5 cm或更小的肿瘤的分期准确性高于大于5 cm的肿瘤（T期：82%对52%，P<0.05；N期：88%对59%，P<0.05；M期：92%对56%，P<0.001）。较大肿瘤T分期准确性低可能是由于排除了局部不可切除或有远处转移的患者。EUS对食管肿瘤的分期也明显更好，尤其是在识别腹腔干转移方面（93%对63%；P<0.001）。
EUS对大于5 cm的肿瘤以及食管胃交界部肿瘤进行食管癌分期的准确性低于大小为5 cm或更小的肿瘤以及食管肿瘤。在做出治疗决策时应考虑这些发现。
