Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
World J Gastroenterol. 2017 Dec 14;23(46):8193-8199. doi: 10.3748/wjg.v23.i46.8193.
To evaluate the accuracy of endoscopic ultrasound (EUS) in early esophageal cancer (EC) performed in a high-volume tertiary cancer center.
A retrospective review of patients undergoing esophagectomy was performed and patients with cT1N0 and cT2N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student's test and Fisher's exact test or χ test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy.
Between 2000 and 2015, 139 patients with clinical stageIorIIA esophageal cancer undergoing esophagectomy were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle third of the esophagus in 11 (8%) and lower third and gastroesophageal junction in 128 (92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. Positron emission tomography (PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients (6%) in whom both EUS and PET were negative for nodal involvement.
EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.
评估在高容量三级癌症中心进行的早期食管癌（EC）内镜超声（EUS）的准确性。
对接受食管切除术的患者进行回顾性审查，并评估 EUS 诊断为 cT1N0 和 cT2N0 食管癌的患者。回顾患者的人口统计学、肿瘤特征和治疗情况。比较 EUS 分期与手术病理以确定 EUS 的准确性。使用描述性统计描述队列。使用学生 t 检验和 Fisher 确切检验或 χ 检验比较变量。使用逻辑回归分析确定肿瘤位置和肿瘤组织学等临床变量是否与 EUS 准确性相关。
在 2000 年至 2015 年间，确定了 139 例接受食管切除术的临床分期 I 或 IIA 食管癌患者。其中女性 25 例（18%），男性 114 例（82%）。肿瘤位置包括食管中段 11 例（8%）和下段及胃食管交界处 128 例（92%）。93%的患者为腺癌。术前 EUS 与 139 例患者中的 73 例最终手术病理相匹配，符合率为 53%。29 例（21%）EUS 分期不足；其中 19 例（14%）存在未识别的淋巴结疾病。62/139 例患者除 EUS 外还使用正电子发射断层扫描（PET）进行临床分期。在 EUS 和 PET 均未发现淋巴结受累的 62 例患者中，仅 4 例（6%）发现隐匿性淋巴结疾病。
EUS 在早期 EC 中的准确性较低，内镜黏膜切除术在某些情况下可能有用。EUS 联合 PET 可提高分期准确性。
