Endosonography (ES) is an important tool for staging malignant esophageal cancer with the TNM staging classification. ES is a safe procedure and an accurate method of staging tumor invasion (T) and lymph node involvement (N).
Methods:
The author reviewed the literature on the comparative roles of computed tomography and ES as complementary staging procedures.
Results:
Advantages of ES in staging esophageal cancer include the ability to accurately determine the layer depth of mural infiltration and to detect metastatic involvement of regional lymph nodes. Its disadvantages include its inability to identify distant metastases, to differentiate inflammation from malignant infiltration of wall layers or in lymph nodes, and to examine beyond obstructing tumors unless esophageal dilation is performed. A recent review indicates the accuracy for T staging to be 84% and N staging to be 77%.
Conclusions:
ES is a valuable tool in staging esophageal cancer and should be used in combination with computed tomography for highest accuracy.
References
1.
SiewertJ.R., DittlerH.J.. Esophageal carcinoma: impact of staging on treatment.Endoscopy.1993; 25: 28–32.
2.
ChakA., CantoM., GerdesH.. Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study.Gastrointest Endosc.1995; 42: 501–506.
3.
TioT.L.. Gastrointestinal TNM Cancer Staging by Endosonography.New York, NY: Igaku-Shoin Medical Publishers, Inc;1995.
4.
BeahrsO.H., HensonD.E., HutterR.V.P. eds. Manual for Staging of Cancer.3rd ed.Philadelphia, Pa: JB Lippincott Co;1992: 57–59.
5.
HoscherA.H., SiewertR., FinkU.. Staging concepts for gastrointestinal malignancies: the importance of preoperative locoregional T- and N-staging.Gastrointest Endosc Clin North Am.1995; 5: 529–536.
6.
ZuccaroG., SivakMVJr, RiceT.W.. Endoscopic ultrasound and the staging of esophageal and gastric cancer.Gastrointest Endosc Clin North Am.1992; 2: 625–636.
7.
RiceT.W., AdelsteinD.J.. Precise clinical staging allows treatment modification of patients with esophageal carcinoma.Oncology.1997; 11(suppl): 58–62.
8.
TioT.L.. The TNM staging system.Gastrointest Endosc.1996; 43(suppl): 19–24.
9.
Van DamJ.. Endosonographic evaluation of the patient with esophageal cancer.Chest.1997; 112(suppl): 184–190.
HalvorsenRAJr, ThompsonW.M.. CT of esophageal neoplasms.Radiol Clin North Am.1989; 27: 667–685.
12.
TaylorC.R.. Carcinoma of the esophagus: current imaging options.Am J Gastroenterol.1986; 81: 1013–1020.
13.
TioT.L., CohenP., CoeneP.P., UddingJ.. Endosonography and computed tomography of esophageal carcinoma: preoperative classification compared to the new (1987) TNM system.Gastroenterology.1989; 96: 1478–1486.
14.
HoldenA., MendelsonR., EdmundsS.. Pre-operative staging of gastrooesophageal junction carcinoma: comparison of endoscopic ultrasound and computed tomography.Australas Radiol.1996; 40: 206–212.
TytgatG.N., TioT.L.. Esophageal ultrasonography.Gastroenterol Clin North Am.1991; 20: 659–671.
17.
Anonymous. Clinical applications of endoscopic ultrasonography in gastroenterology: state of the art 1993. Results of a consensus conference, Orlando, Florida, January 19, 1993.Endoscopy.1993; 25: 358–366.
18.
ChandawarkarR.Y., KakegawaT., FujitaH.. Endosonography for preoperative staging of specific nodal groups associated with esophageal cancer.World J Surg.1996; 20: 700–702.
19.
RoschT.. Endosonographic staging of esophageal cancer: a review of literature results.Gastrointest Endosc Clin North Am.1995; 5: 537–547.
20.
KallimanisG.E., GuptaP.K., al-KawasF.H.. Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe.Gastrointest Endosc.1995; 41: 540–546.
21.
MassariM., CioffiU., De SimoneM.. Endoscopic ultrasonography for preoperative staging of esophageal carcinoma.Surg Laparosc Endosc.1997; 7: 162–165.
22.
MurataY., SuzukiS., HashimotoH.. Endoscopic ultrasonography of the upper gastrointestinal tract.Surg Endosc.1988; 2: 180–183.
23.
FrancioniF., NishihiraT., MasudaM.. The significance of pre-operative diagnosis of esophageal cancer using esophageal mediastinal ultrasonography.Tohoku J Exp Med.1987; 152: 1–14.
24.
AibeT., ItoT., YoshidaT.. Endoscopic ultrasonography of lymph nodes surrounding the upper GI tract.Scand J Gastroenterol.1986; 123(suppl): 164–169.
LightdaleC.J., BotetJ.F., KelsenD.P.. Diagnosis of recurrent upper gastrointestinal cancer at the surgical anastomosis by endoscopic ultrasound.Gastrointest Endosc.1989; 35: 407–412.
27.
GiovanniniM., SeitzJ.F., ThomasP.. Endoscopic ultrasonography for assessment of the response to combined radiation therapy and chemotherapy in patients with esophageal cancer.Endoscopy.1997; 29: 4–9.
28.
CatalanoM.F., SivakMVJr, RiceT.W.. Postoperative screening for anastomotic recurrence of esophageal carcinoma by endoscopic ultrasonography.Gastrointest Endosc.1995; 42: 540–544.
29.
FockensP., ManshandenC.G., vanLanschot. Prospective study on the value of endosonographic follow-up after surgery for esophageal carcinoma.Gastrointest Endosc.1997; 46: 487–491.
YoshidaS.. Endoscopic diagnosis and treatment of early cancer in the alimentary tract.Digestion.1998; 59: 502–508.
32.
BotetJ.F., LightdaleC.J., ZauberA.G.. Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT.Radiology.1991; 181: 419–425.
