Department of Medicine B, Münster University Hospital, Münster, Germany.
Surg Endosc. 2013 Aug;27(8):2813-9. doi: 10.1007/s00464-013-2817-7. Epub 2013 Feb 13.
Despite recent advances in imaging techniques, adequate classification of esophageal lesions is still challenging. Accurate staging of tumors of the esophagus is a precondition for targeted therapy. In this retrospective, multicenter study, we report the role of high-frequency endoscopic ultrasound (EUS) catheter probes in pretherapeutic staging of esophageal neoplasms and thus guiding treatment decisions.
A total of 143 patients (mean age of 63.8 ± 10.7 years) with esophageal carcinoma were recruited from five German centers (Münster, Oldenburg, Hannover, Wiesbaden, and Lüneburg). Tumor type was adenocarcinoma in 112 (78 %) cases and squamous cell carcinoma in 31 (22 %). Tumor localization was as follows: proximal 3, mid esophagus 7, and distal third 133. Histological correlation either through EMR or surgery was available. In all patients, pretherapeutic uT and uN classifications were compared to pT/pN classification obtained from surgically (esophagectomy, n = 93) or endoscopically (EMR, n = 50) resected tissue.
Overall, accuracy of uT classification was 60 % and of uN classification was 74 %. Sensitivity, specificity, and accuracy rates for local tumor extension were as follows (%): T1: 68/97/83; T2: 39/84/75; T3: 72/81/79; T4: 13/97/93; T1/2: 73/81/75; T3/4: 78/82/81. Relating to positive lymph node detection, sensitivity and specificity were 76 and 71 %, respectively.
Miniprobe EUS is an established method for the staging of esophageal tumors. Our large multicenter cohort shows a solid accuracy of miniprobe EUS with respect to differentiating locally advanced from limited cancer and assisting to determine the treatment regimen in the era of neoadjuvant therapy; consequently, 78 % of patients would have been assigned to the adequate therapeutic regimen, whereas 11 % of patients would have been overtreated and 11 % undertreated.
尽管成像技术取得了最近的进展，但食管病变的充分分类仍然具有挑战性。准确分期食管肿瘤是靶向治疗的前提。在这项回顾性多中心研究中，我们报告了高频内镜超声（EUS）探头在食管肿瘤的治疗前分期中的作用，并指导治疗决策。
共有来自德国五个中心（明斯特、奥尔登堡、汉诺威、威斯巴登和吕讷堡）的 143 名食管癌患者（平均年龄 63.8 ± 10.7 岁）入组。112 例（78%）为腺癌，31 例（22%）为鳞状细胞癌。肿瘤定位如下：近端 3 例，中段 7 例，远端 133 例。所有患者均通过 EMR 或手术获得了组织学相关性。在所有患者中，术前 uT 和 uN 分类与手术（食管切除术，n=93）或内镜（EMR，n=50）切除组织获得的 pT/pN 分类进行了比较。
总体而言，uT 分类的准确性为 60%，uN 分类的准确性为 74%。局部肿瘤延伸的灵敏度、特异性和准确性分别为（%）：T1：68/97/83；T2：39/84/75；T3：72/81/79；T4：13/97/93；T1/2：73/81/75；T3/4：78/82/81。在检测阳性淋巴结方面，灵敏度和特异性分别为 76%和 71%。
微型探头 EUS 是一种用于分期食管肿瘤的成熟方法。我们的大型多中心队列表明，微型探头 EUS 在区分局部进展期和局限性癌症方面具有良好的准确性，并有助于在新辅助治疗时代确定治疗方案；因此，78%的患者将被分配到适当的治疗方案，11%的患者将被过度治疗，11%的患者将被治疗不足。
