Department of Internal Medicine, HSK Wiesbaden, Wiesbaden, Germany.
Endoscopy. 2010 Jun;42(6):456-61. doi: 10.1055/s-0029-1244022. Epub 2010 Mar 19.
Endoscopic ultrasound (EUS) has been regarded as the most accurate staging tool in esophageal cancer. Staging results have a strong impact on the decision as to whether a patient should undergo endoscopic treatment, surgery alone, or neoadjuvant therapy. This retrospective study was conducted to analyze the accuracy of esophageal cancer staging using EUS.
All patients who received EUS for staging of esophageal cancer before esophagectomy from February 2003 to December 2007 at a high volume academic tertiary care center were included.
179 consecutive patients (mean age 64.4 +/- 9.5 years; 142 men) underwent esophageal resection for Barrett's adenocarcinoma (n = 134) and squamous cell cancer (n = 45). Postoperatively, 99 patients were staged as having T1 cancers (55 %), 30 patients T2 (17%), 46 patients T3 (26%), and four patients T4 (2%). The sensitivity and specificity of EUS relative to the T stage were 82% and 91%, respectively, for T1; 43% and 85% for T2; and 83% and 86% for T3. The overall accuracy for EUS in identifying the correct T stage was 74% (95%CI 66-80). Positive lymph nodes were diagnosed histologically in 68 patients (38%). The sensitivity, specificity and accuracy of EUS for the diagnosis of N1 were 71%, 74% and 73% (95%CI 65-79), respectively.
The diagnostic accuracy of EUS in patients with esophageal cancer is still unsatisfactory. T2 cancers in particular are frequently overstaged, with a significant effect on the subsequent treatment strategy.
内镜超声（EUS）已被认为是食管癌最准确的分期工具。分期结果对决定患者是否应接受内镜治疗、单独手术或新辅助治疗有很大影响。本回顾性研究旨在分析 EUS 对食管癌分期的准确性。
所有在高容量学术三级护理中心接受 EUS 分期以进行食管癌切除术的患者均纳入本研究。
179 例连续患者（平均年龄 64.4 +/- 9.5 岁；142 名男性）因 Barrett 腺癌（n = 134）和鳞状细胞癌（n = 45）接受食管切除术。术后，99 例患者分期为 T1 癌（55%），30 例患者为 T2（17%），46 例患者为 T3（26%），4 例患者为 T4（2%）。EUS 相对于 T 分期的敏感性和特异性分别为 T1 为 82%和 91%；T2 为 43%和 85%；T3 为 83%和 86%。EUS 正确识别 T 分期的总体准确性为 74%（95%CI 66-80）。68 例患者（38%）组织学诊断阳性淋巴结。EUS 对 N1 的诊断敏感性、特异性和准确性分别为 71%、74%和 73%（95%CI 65-79）。
EUS 对食管癌患者的诊断准确性仍不理想。特别是 T2 癌症经常被高估，这对随后的治疗策略有重大影响。
