Department of Surgery, Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center, University of Montréal, Montréal, Québec, Canada.
Ann Thorac Surg. 2013 Jul;96(1):232-6: discussion 236-8. doi: 10.1016/j.athoracsur.2013.03.023. Epub 2013 May 8.
The gold standard for staging the local extension (T stage) and lymph node (LN) status (N stage) of esophageal cancer is endoscopic ultrasonography (EUS). When biopsy of the peritumoral LNs is performed using EUS, there is a risk of specimen contamination secondary to piercing the primary tumor; this shortcoming can be circumvented with endobronchial ultrasonography (EBUS). Moreover, EBUS allows for biopsy of LN stations not accessible with EUS.
The study consisted of a prospective clinical trial. Fifty-two consecutive patients with potentially resectable esophageal cancer referred for endoscopic staging were prospectively enrolled. Radial and convex EUS followed by convex EBUS were performed during a single staging procedure. The LNs not accessible by EUS were biopsied using EBUS. Results of the EBUS procedure were compared to those of EUS in terms of the addition of staging information, upstaging, and confirmation of stage.
The combined EBUS-EUS procedure was performed in 42 patients. Ten patients were excluded. In all, 54 LNs were biopsied under EUS guidance and 48 LNs were biopsied under EBUS guidance. The EUS results were positive for metastatic esophageal cancer in 29 LNs (54%), and EBUS was positive in 10 LNs (21%). The addition of EBUS to EUS in the staging of esophageal cancer led to nodal and patient upstaging in 5 patients (12%) and confirmed the EUS stage with additional negative or positive LN sampling in 29 patients (69%). Positive EBUS that led to upstaging (5 patients) changed the treatment plan from potentially resectable to palliative. There was no morbidity related to EBUS.
A combined EBUS-EUS staging procedure improves precision in staging, leads to upstaging, and can change the treatment plan in patients with esophageal cancer.
内镜超声检查（EUS）是评估食管癌局部扩展（T 分期）和淋巴结（LN）状态（N 分期）的金标准。当使用 EUS 对肿瘤周围的 LN 进行活检时，由于穿刺原发肿瘤，存在标本污染的风险；这一缺点可以通过支气管内超声检查（EBUS）来规避。此外，EBUS 还可以对 EUS 无法触及的 LN 部位进行活检。
本研究为前瞻性临床试验。52 例潜在可切除食管癌患者连续入组，行内镜分期。在单一分期过程中进行径向和凸面 EUS 检查，然后进行凸面 EBUS 检查。对 EUS 无法触及的 LN 采用 EBUS 进行活检。比较 EBUS 检查结果与 EUS 检查在分期信息增加、分期升级和分期确认方面的差异。
联合 EBUS-EUS 检查在 42 例患者中进行。10 例患者被排除。总共在 EUS 引导下对 54 个 LN 进行了活检，在 EBUS 引导下对 48 个 LN 进行了活检。EUS 结果显示 29 个 LN（54%）存在转移性食管癌，EBUS 结果为阳性 10 个 LN（21%）。在食管癌分期中，将 EBUS 与 EUS 联合应用，导致 5 例（12%）患者出现淋巴结和患者分期升级，并在 29 例（69%）患者中通过额外的阴性或阳性 LN 取样确认了 EUS 分期。导致分期升级的阳性 EBUS（5 例）改变了潜在可切除患者的治疗计划为姑息治疗。没有与 EBUS 相关的发病率。
联合的 EBUS-EUS 分期检查提高了分期的准确性，导致分期升级，并可改变食管癌患者的治疗计划。
