Maple J T, Peifer K J, Edmundowicz S A, Early D S, Meyers B F, Jonnalagadda S, Azar R R
Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA.
Dis Esophagus. 2008;21(6):480-7. doi: 10.1111/j.1442-2050.2007.00804.x.
Accurate staging of esophageal cancer is critical to achieving optimal treatment outcomes. End-oscopic ultrasound with fine needle aspiration (EUS-FNA) has emerged as a valuable tool for locoregional staging. However, it is unclear how different physician specialties perceive the benefit of EUS-FNA for esophageal cancer staging, and thus utilize this modality in clinical practice. A survey regarding utilization of EUS-FNA in esophageal cancer was distributed to 211 thoracic surgeons and 251 EUS-capable gastroenterologists. Seventy-six thoracic surgeons (36%) and 78 gastroenterologists (31%) responded to the survey. Most surgeons (75%) use EUS to stage potentially resectable esophageal cancer 75% of the time. Surgeons using EUS less often are less likely to have access to high-quality EUS services than their peers. Fewer surgeons believe EUS is the most accurate test for T and N-staging (84% and 71%, respectively) as compared with gastroenterologists (97% and 96%, P < 0.01 for both). Most endosonographers (68%) decide whether to dilate a malignant esophageal stricture to complete the staging exam on a case-by-case basis. Surgeons disagree as to whether involvement of celiac lymph nodes should preclude esophagectomy in distal esophageal cancer. While most thoracic surgeons have embraced EUS-FNA as the most accurate locoregional staging modality in esophageal cancer, this attitude is not fully reflected in utilization patterns due to a lack of quality EUS services in some centers. Controversial areas that warrant further study include dilation of malignant strictures to facilitate EUS staging, and the implication of involved celiac lymph nodes on management.
准确的食管癌分期对于实现最佳治疗效果至关重要。超声内镜引导下细针穿刺活检（EUS-FNA）已成为局部区域分期的重要工具。然而，尚不清楚不同专业的医生如何看待EUS-FNA对食管癌分期的益处，以及在临床实践中如何使用这种方法。一项关于EUS-FNA在食管癌中应用情况的调查，发放给了211名胸外科医生和251名具备EUS操作能力的胃肠病学家。76名胸外科医生（36%）和78名胃肠病学家（31%）回复了该调查。大多数外科医生（75%）在75%的情况下使用EUS对潜在可切除的食管癌进行分期。与同行相比，较少使用EUS的外科医生获得高质量EUS服务的机会更少。与胃肠病学家（分别为97%和96%，两者P均<0.01）相比，更少的外科医生认为EUS是T分期和N分期最准确的检查方法（分别为84%和71%）。大多数超声内镜检查医生（68%）会根据具体情况决定是否扩张恶性食管狭窄以完成分期检查。对于腹腔淋巴结受累是否应排除远端食管癌的食管切除术，外科医生存在分歧。虽然大多数胸外科医生已接受EUS-FNA作为食管癌最准确的局部区域分期方法，但由于一些中心缺乏高质量的EUS服务，这种态度在使用模式中并未得到充分体现。值得进一步研究的争议领域包括扩张恶性狭窄以利于EUS分期，以及受累腹腔淋巴结对治疗的影响。
