ENDOSCOPIC ULTRASONOGRAPHY IN THE PREOPER ATIVE STAGING OF ESOPHAGEAL-CARCINOMA

Objective: To assess the diagnostic accuracy of endoscopic ultrasonogr aphy (EUS) for the local and regional staging of esophageal cancer, an d its possible alteration resulting from the performance of preoperati ve chemoradiation. Methods: Prospective study of 85 consecutive patien ts with esophageal cancer evaluated by EUS and operated on between Jan uary 1992 and December 1995. 28 of these patients had received previou s induction therapy. In all cases, EUS examination was performed by th e same physician not informed about the results of previous morphologi cal explorations. Histopathological analysis of all operative specimen s was performed by the same pathologist, not informed about the result s of EUS. Data were collected by another independent observer. Results : EUS examination resulted in incomplete staging in 8 patients (9,5 %) with severe stenosis precluding endoscope passage. The accuracy, spec ificity and sensitivity of EUS in detecting the depth of esophageal in volvement (T0-2 vs. T3-4) were 82.3 %, 78 %, and 86 % respectively, an d 72 %, 70 %, and 73 % respectively for lymph node metastasis. stage w as 67 %, with a clear-cut alteration when patients had received induct ion therapy (61 % vs 72 %). On the other hand, 7 (64 %) of the 11 pati ents thought to have a complete response at endosonography had no resi dual tumor. Conclusion. EUS provides precise information for the preop erative identification of locally advanced esophageal tumor, even afte r induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds of cas es.