Kahlon Sartajdeep, Aamar Ali, Butt Zeeshan, Urayama Shiro
Department of Internal Medicine, University of California-Davis, Sacramento, CA 95817, United States.
Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, United States.
World J Gastrointest Endosc. 2023 Jun 16;15(6):447-457. doi: 10.4253/wjge.v15.i6.447.
Endoscopic ultrasound (EUS) stands as an accurate imaging modality for esophageal cancer staging, however utilization of EUS in early-stage cancer management remains controversial. Identification of non-applicability of endoscopic interventions with deep muscular invasion with EUS in pre-intervention evaluation of early-stage esophageal cancer is compared to endoscopic and histologic indicators.
To display the role of EUS in pre-intervention early esophageal cancer staging and how the index endoscopic features of invasive esophageal malignancy compare for prediction of depth of invasion and cancer management.
This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center from 2012 to 2022. Patient clinical data, initial esophagogastroduodenoscopy/biopsy, EUS, and final resection pathology reports were abstracted, and statistical analysis was conducted to assess the role of EUS in management decisions.
Forty nine patients were identified for this study. EUS T stage was concordant with histological T stage in 75.5% of patients. In determining submucosal involvement (T1a T1b), EUS had a specificity of 85.0%, sensitivity of 53.9%, and accuracy of 72.7%. Endoscopic features of tumor size > 2 cm and the presence of esophageal ulceration were significantly associated with deep invasion of cancer on histology. EUS affected management from endoscopic mucosal resection/submucosal dissection to esophagectomy in 23.5% of patients without esophageal ulceration and 6.9% of patients with tumor size < 2 cm. In patients without both endoscopic findings, EUS identified deeper cancer and changed management in 4.8% (1/20) of cases.
EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity. Data validated endoscopic indicators suggested superficial cancers in the group with a tumor size < 2 cm and the lack of esophageal ulceration. In patients with these findings, EUS rarely identified a deep cancer that warranted a change in management.
内镜超声（EUS）是食管癌分期的一种准确成像方式，然而EUS在早期癌症管理中的应用仍存在争议。在早期食管癌的干预前评估中，将EUS用于识别内镜干预对深层肌肉浸润不适用的情况与内镜及组织学指标进行比较。
展示EUS在干预前早期食管癌分期中的作用，以及侵袭性食管恶性肿瘤的内镜特征指标在预测浸润深度和癌症管理方面的比较情况。
这是一项对2012年至2022年在一家三级医疗中心被诊断为食管癌后接受切除术前EUS检查的患者的回顾性研究。提取患者的临床数据、初始食管胃十二指肠镜检查/活检、EUS及最终切除病理报告，并进行统计分析以评估EUS在管理决策中的作用。
本研究纳入49例患者。EUS T分期与组织学T分期在75.5%的患者中一致。在确定黏膜下受累情况（T1a对T1b）时，EUS的特异性为85.0%，敏感性为53.9%，准确性为72.7%。肿瘤大小>2 cm及存在食管溃疡的内镜特征与组织学上癌症的深层浸润显著相关。在无食管溃疡的患者中，EUS使23.5%的患者管理方式从内镜黏膜切除术/黏膜下剥离术转变为食管切除术；在肿瘤大小<2 cm的患者中，这一比例为6.9%。在无上述两种内镜表现的患者中，EUS在4.8%（1/20）的病例中识别出更深层的癌症并改变了管理方式。
EUS在排除黏膜下浸润方面具有合理的特异性，但敏感性相对较差。数据验证了内镜指标提示肿瘤大小<2 cm且无食管溃疡的组为浅表癌。在有这些表现的患者中，EUS很少识别出需要改变管理方式的深层癌症。
