Endoscopic ultrasound (EUS) in patients with esophageal cancer is a useful diagnostic tool for locoregional tumor staging. Patients with advanced esophageal cancer receive neoadjuvant radiochemotherapy to downstage the tumor prior to surgery. The role and accuracy of EUS after neoadjuvant therapy is uncertain.
Between 2002 and 2005 we prospectively enrolled 70 consecutive patients with localized esophageal cancer who received neoadjuvant radiochemotherapy before esophagectomy and were evaluated prior and after neoadjuvant therapy. In 16 patients EUS staging was not performed due to esophageal stenosis. All patients underwent esophagectomy and specimens were reviewed for T and N category. EUS results were then compared to the pathologic findings.
There were 44 male and 10 female with a mean age of 56 years (SD±5.6). 28 patients had squamous cell cancer and 26 patients had adenocarcinoma. The pathologic tumor stage was as followed: ypT0 n=10, ypT1 n=5, ypT2 n=11, ypT3 n=27, and ypT4 n=1. The overall accuracy for EUS after neoadjuvant therapy was determined as 39.6% for T status and 61.7% for N status. The sensitivity in EUS for T category was 40% for uT0, 0% for uT1, 18% for uT2, 55.6% for uT3, and 0% for uT4. The T category was overestimated in 36.2% and underestimated in 23.4%. The sensitivity and specificity for positive lymph node status was 64% and 58.6%, respectively. Tumor cell type and tumor location did not influence the EUS staging.
Endosonographic staging after neoadjuvant therapy is not as accurate as it is reported for the initial staging. The prognostic value to predict downstaging is low, especially in tumors with good response and low T category.
Program Number: P279