Radial EUS: The clinical impact of T staging
Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Minerva medica
(Impact Factor: 0.91).
Endoscopic ultrasound staging of gastrointestinal and pancreaticobiliary cancers is important in guiding the choice of an appropriate treatment strategy such as endoscopic mucosal resection, surgery or palliative chemotherapy. This review will summarize the principles of endoscopic ultrasound T staging using a radial echoendoscope, elaborate on the accuracy rate in T staging, and discuss the clinical impact of endoscopic ultrasound T staging in the context of esophageal, gastric and pancreaticobiliary cancers.
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ABSTRACT: Endoscopic ultrasound was initially introduced in the 1980s as a diagnostic modality using echoendoscopes with radial scanning that permitted reconstruction of cross-sectional images similar to computed tomography The close proximity of the ultrasound transducer to the gastrointestinal wall and retroperitoneal structures allowed a detailed examination that is not possible with cross-sectional imaging such as computed tomography and magnetic resonance imaging. It proved to be highly accurate and useful in the staging of gastrointestinal malignancies, as well as in characterizing the nature of subepithelial lesions and disorders of the pancreaticobiliary system. The introduction of linear echoendoscopes facilitated fine needle aspiration because, with linear scanning, it was able to trace the path of the tip of the needle during the puncture process. In addition to being very useful for tissue acquisition for diagnostic purposes, the principles behind endoscopic ultrasound-guided fine needle aspiration paved the way for the development of therapeutic endoscopic ultrasound. Substances could now be delivered by endoscopic ultrasound into targeted areas, an example being an endoscopic ultrasound-guided celiac plexus block and neurolysis. In addition, the endoscopic ultrasound-guided puncture of fluid collections, abscesses and obstructed biliary and pancreatic ductal systems facilitated the passage of guidewires, thus allowing therapeutic drainage procedures to be performed using the Seldinger technique. This review summarizes the diagnostic capability of endoscopic ultrasound and then moves on to elaborate in detail its therapeutic capability and potential.
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ABSTRACT: To correlate primary oesophageal squamous cell carcinoma (SCC) (18)F-fluoro-deoxyglucose (FDG) uptake with pathological factors and examine its significance regarding choice of therapy.
We retrospectively examined the factors affecting visible and non-visible FDG uptake in 37 primary lesions in 32 oesophageal SCC patients who underwent PET/CT before oesophagectomy or endoscopic submucosal dissection (ESD). We divided the lesions into pathological depth invasion ≥sm2 oesophagectomy (n = 18) and ≤sm1 ESD (n = 19) indicated groups and compared the diagnostic accuracy of FDG-PET with that of endoscopic ultrasound (EUS) performed for 23 superficial lesions to discriminate between these groups.
There were 17 visible and 20 non-visible lesions. The lesion visibility was significantly higher in the larger (≥40 mm), non-flat type, more deeply invaded, positive vascular invasion (P < 0.001 each), positive nodal metastasis (P = 0.04) and higher Glut-1 score (P = 0.005) tumour groups. When the visible and non-visible lesions indicated a need for oesophagectomy and ESD respectively, the sensitivity, specificity and accuracy of oesophagectomy were 94% (17/18), 100% (19/19) and 97% (36/37) and those of EUS were 75% (3/4), 79% (15/19) and 78% (18/23) respectively.
Primary lesion FDG visibility can be one of the indicators for choosing between oesophagectomy and ESD for resectable oesophageal SCCs.
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