Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy

Background. In past years multimodal neoadjuvant treatment for carcinoma of the esophagus has been used with increased frequency. Staging of the neopl asm still remains fundamental in evaluating the response to therapy and in planning operation. The aim of the present study was to assess the accuracy of endoscopic ultrasonography (EUS) in a group of patients with squamous c ell carcinoma of the thoracic esophagus after undergoing radiotherapy and c hemotherapy. Methods. Among a group of 111 patients with squamous cell carcinoma of the thoracic esophagus and treated with preoperative radiotherapy and chemother apy, 87 were operated. In these patients it was possible to compare the res ults of EUS, with regard to depth of invasion of esophageal wall (T) and ly mph node involvement (N), with the results of operation and histopathologic study. Results. Feasibility of EUS before and after neoadjuvant treatment was 71.2 % and 83.9%, respectively. The overall accuracy of EUS regarding the wall i nvasion was 47.9%. The more frequent error was overstaging, especially in p atients with complete response and in patients with minimal residual diseas e. In the assessment of lymph node involvement EUS showed an overall accura cy of 71.2% with a moderate kappa value. Sensitivity for N1 and NO was 73.7 % and 68.6%, respectively. Conclusions. Endoscopic ultrasonography was feasible in most patients after preoperative radiotherapy and chemotherapy, but our study documented a wor sening of accuracy of EUS in the evaluation of T attributable to the confou nding presence of radiation fibrosis and soft tissue reaction after radioth erapy and chemotherapy. (Ann Thorac Surg 1999;67:1466-9) (C) 1999 by The So ciety of Thoracic Surgeons.