Document Detail


Endoscopic ultrasound in esophageal carcinoma: comparison with multislice computed tomography and importance in the clinical decision making process.
MedLine Citation:
PMID:  17641581     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: As resective surgery for oesophageal carcinoma is only appropriate for a selected cohort of patients, preoperative staging plays an important role in the management of these patients. This study assessed the accuracy of endoscopic ultrasound (EUS) staging in comparison with computerised tomography (CT) staging and the impact of EUS in management of patients with oesophageal carcinoma undergoing gastro-esophagectomy. METHODS: Ninety-six consecutive patients with oesophageal carcinoma underwent preoperative staging with multislice CT and EUS. Of these, 50 patients underwent gastro-esophagectomy, allowing preoperative staging data from these imaging modalities to be compared to postoperative histopathological staging, classified according to the TNM system. Management plans for these patients made without use of EUS were then compared to those following EUS staging. RESULTS: The overall accuracy rate of EUS for T staging was 64%, showing good agreement with postoperative histopathological staging of the resected specimen (weighted k=0.42, 95%CI= 0.32-0.52). In terms of clinical decision making, the T stage accuracy rose to 90% when differentiating T1 from T2/3 lesions. In terms of N staging, the overall accuracy was 72% (weighted k=0.44, 95% CI=0.34-0.54). In comparison, N staging by CT was significantly less accurate (62% vs 72%, P<0.01, chi squared) and showed poor agreement with postoperative histopathological nodal staging (weighted k=0.24, 95%CI =0.11-0.37). Importantly, in 56% of patients, staging information obtained from EUS instigated change in management compared to that configured without EUS. CONCLUSION: EUS enhances preoperative staging of oesophageal cancer and is important in preoperative clinical decision making process, especially with increasing use of neoadjuvant chemotherapy.
Authors:
N Moorjani; M Junemann-Ramirez; O Judd; B Fox; J S Rahamim
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Minerva chirurgica     Volume:  62     ISSN:  0026-4733     ISO Abbreviation:  Minerva Chir     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-20     Completed Date:  2008-02-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400726     Medline TA:  Minerva Chir     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  217-23     Citation Subset:  IM    
Affiliation:
Department of Thoracic Surgery, Derriford Hospital, Plymouth, UK. narain.moorjani@doctors.org.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Carcinoma / diagnosis,  radiography*,  therapy,  ultrasonography*
Endosonography*
Esophageal Neoplasms / diagnosis,  radiography*,  therapy,  ultrasonography*
Esophagectomy
Female
Gastrectomy
Humans
Male
Middle Aged
Neoadjuvant Therapy / methods
Neoplasm Staging
Retrospective Studies
Tomography, X-Ray Computed*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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