National Naval Medical Center, Bethesda, Maryland 20889, USA.
Clin Gastroenterol Hepatol. 2010 Dec;8(12):1037-41. doi: 10.1016/j.cgh.2010.08.020. Epub 2010 Sep 8.
BACKGROUND & AIMS: Patients with esophageal high-grade dysplasia or mucosal esophageal cancer can be successfully treated by endoscopy. We performed a systematic review of the literature to determine whether endoscopic ultrasound (EUS) correctly predicts the T-stage of early esophageal cancers, compared with pathology specimens obtained by using endoscopic mucosal resection (EMR) or surgery.
Standard systematic review methods were used to perform reference searches, determine eligibility, abstract data, and analyze data. When possible, individual patient-level data were abstracted, in addition to publication-level aggregate data.
Twelve studies had sufficient information to abstract and review for quality; 8 had individual patient-level data (n = 132). Compared with surgical or EMR pathology staging, EUS had T-stage concordance of 65%, including all studies (n = 12), but only 56% concordance when limited to individual patient-level data. Factors such as initial biopsy pathology (high-grade dysplasia vs early-stage cancer) did not appear to affect the concordance of staging between EUS and EMR/surgical staging.
EUS is not sufficiently accurate in determining the T-stage of high-grade dysplasias or superficial adenocarcinomas; other means of staging, such as EMR, should be used.
食管高级别上皮内瘤变或黏膜食管癌患者可通过内镜成功治疗。我们进行了系统综述，以确定与内镜黏膜切除术（EMR）或手术获得的病理标本相比，内镜超声（EUS）是否能正确预测早期食管癌的 T 分期。
采用标准系统综述方法进行文献检索、确定纳入标准、提取数据和分析数据。如果可能，还提取了个体患者水平的数据，除了出版水平的汇总数据。
有 12 项研究有足够的信息进行抽象和质量审查；8 项研究有个体患者水平的数据（n = 132）。与手术或 EMR 病理分期相比，EUS 的 T 分期一致性为 65%，包括所有研究（n = 12），但仅限于个体患者水平数据时，一致性为 56%。初始活检病理（高级别上皮内瘤变与早期癌症）等因素似乎并不影响 EUS 与 EMR/手术分期之间的分期一致性。
EUS 在确定高级别上皮内瘤变或表浅腺癌的 T 分期方面不够准确；应采用其他分期方法，如 EMR。
