Endoscopic ultrasound beats CT for managing esophageal carcinoma

Endoscopic ultrasound has been shown to provide better information than CT for the staging of esophageal carcinoma. Only certain tumors can be successfully removed, so knowing the stage of cancer is vital to preparing the most effective treatment plan, especially when considering neoadjuvant chemotherapy.

Researchers performed both CT and endoscopic ultrasound scans on esophageal carcinoma patients and compared treatment plans made after each scan. They also compared staging achieved with the imaging technologies with postoperative histopathological staging, classified according to the TNM system.

Dr. Narain Moorjani and colleagues in the department of thoracic surgery at Derriford Hospital in Plymouth, U.K., published their study in the August issue of the Italian journal Minerva Chirurgica. Ninety-six consecutive esophageal cancer patients had both CT and endoscopic ultrasound exams to determine the stage of their tumors. Fifty later underwent a gastroesophagectomy, allowing for direct comparisons between postoperative histopathological staging and the two methods of preoperative staging. Management plans created after each scan were also compared.

In 56% of patients, management plans created using staging from CT scans were changed after staging with endoscopic ultrasound. Endoscopic ultrasound staging also showed good agreement with postoperative histopathological staging of the resected tumor, with an accuracy rate of 64%. This rose to 90% when differentiating T1 from T2/3 lesions. For evaluating involvement of regional lymph nodes, endoscopic ultrasound had an accuracy rate of 72%, while CT's rate was only 62%.

The researchers concluded that endoscopic ultrasound is an mportant tool in the preoperative clinical decision-making process. It enhances the preoperative staging of esophageal cancer, especially with the increasing use of neoadjuvant chemotherapy to shrink tumors to a point where they can be operated on.