The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography

University of Wisconsin–Madison, Madison, Wisconsin, United States
Gastrointestinal Endoscopy (Impact Factor: 5.37). 04/2007; 65(3):377-84. DOI: 10.1016/j.gie.2006.12.015
Source: PubMed


EUS, CT, and positron emission tomography (PET) have all been used in the preoperative staging of esophageal cancer separately or in various combinations.
Our purpose was to determine the value and role of EUS when used in conjunction with CT and PET imaging in staging cancer of the esophagus and gastroesophageal junction.
Retrospective single-center clinical trial.
Academic tertiary care center.
Data were examined for 56 patients who concomitantly underwent examination with EUS, CT, and PET in a multimodality staging program.
EUS, CT, and PET were examined for their ability to detect the primary tumor, local tumor stage, locoregional adenopathy, and distant metastases. With use of surgical resection as baseline therapy, the frequency at which EUS, CT, and PET affected and changed management was examined.
EUS is the only imaging test that identified all primary tumors and provided tumor staging. EUS identified a significantly greater number of patients (58.9%) with locoregional nodes than did CT (26.8%), P = .0006, or PET (37.5%), P = .02. CT identified 14.3% and PET identified 26.8% of patients with distant metastases. With CT alone, 15.2% of patients were not taken to surgery, whereas PET affected management by preventing surgery because of metastatic disease in 28.3% of patients. EUS changed management by guiding the need for neoadjuvant therapy in 34.8% of patients.
Retrospective study, nonblinded study, lack of pathologic reference standard.
The primary strength of EUS in a multimodality staging strategy is in identifying patients with locally advanced disease and guiding the need for preoperative neoadjuvant therapy. EUS is not suited to determine resectability of esophageal cancer alone and thus is most effective when used in conjunction with other imaging tests such as CT and PET.

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    • "It provides key information regarding local tumor invasion, locoregional, and celiac lymph node involvement. This information is essential to guide future treatment decisions [1] [2] [3] [4] [5] [6] [7] [8] [9]. Often a malignant stricture is present that prohibits passage of the echoendoscope for complete EUS staging. "
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    ABSTRACT: Background. Dilation of malignant strictures in endoscopic ultrasound (EUS) staging of esophageal cancer is safe, but no data exists regarding the subsequent development of metastases. Aim. Compare the rates of metastases in esophageal cancer patients undergoing EUS staging who require esophageal dilation in order to pass the echoendoscope versus those who do not. Methods. We reviewed consecutive patients referred for EUS staging of esophageal cancer. We evaluated whether dilation was necessary in order to pass the echoendoscope, and for the subsequent development of metastases after EUS at various time intervals. Results. Among all patients with similar stage (locally advanced disease, defined as T3, N0, M0 or T1-3, N1, M0), there was no difference between the dilated and nondilated groups in the rates of metastases at 3 months (14% versus 10%), P = 1.0, 6 months (28% versus 20%), P = 0.69, 12 months (43% versus 40%), P = 1.0, or ever during a mean followup of 15 months (71% versus 55%), P = 0.48. Conclusions. Dilation of malignant strictures for EUS staging of esophageal cancer does not appear to lead to higher rates of distant metastases.
    Diagnostic and Therapeutic Endoscopy 11/2011; 2011:356538. DOI:10.1155/2011/356538
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    • "On the other hand, although recent studies on other GI-cancers (i.e. esophageal) supported that management changes were more often due to EUS than PET or CT, the type of management changes were different: EUS mainly switched decisions towards neoadjuvant therapy, whereas PET and CT would find distant metastases, thus preventing primary or secondary surgery [25]. In another study setting, a retrospective selection of cases was made and a detailed history – with and without EUS – was presented to 4 surgeons, who would decide for the best treatment under both scenarios; although inter-observer agreement was poor, management was changed in a third of cases with EUS, mostly (85%) switching patients from surgery to palliation [26]. "
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    ABSTRACT: In this review we summarize latest data on the role of endoscopic ultrasonography (EUS) in the diagnosis and management of gastric carcinoma. Since its initial introduction in clinical practice, EUS has been considered a valuable tool for the diagnosis and locoregional staging of gastric cancer and a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes. Moreover, another application of EUS, i.e. its role in the assessment of early gastric cancer has come into focus, especially nowadays in the era of endoscopic mucosal resection and endoscopic submucosal dissection. These topics, together with other aspects of EUS in gastric cancer are discussed. On the other hand, despite its indisputable value, EUS for gastric cancer evaluation is "threatened" nowadays by other modern cross-sectional imaging methods (including trans-abdominal ultrasound, CT, MRI and PET), whose quality has lately improved. A brief comparison between the available imaging methods, attempts to show that their role ismore complementary than competitive.
    Annals of Gastroenterology 03/2011; 24(1):9-15.
    • "Endoscopic ultrasound (EUS) provides more accurate and cost-effective T-staging and N-staging than 18F-FDG PET/CT and conventional CT26–28 and remains the standard for local tumor evaluation.29 The most important role of 18F-FDG PET/CT in the initial staging of esophageal cancer lies in M-staging (Figure 4) through its ability to identify unexpected metastases (i.e., metastases not visible on conventional imaging), which are present in up to 30% of the patients. "
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    ABSTRACT: Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of management is changed. This review provides guidance for oncologists/radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.
    Annals of Saudi medicine 03/2011; 31(1):3-13. DOI:10.4103/0256-4947.75771 · 0.49 Impact Factor
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