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Endobronchial Ultrasound Improves the Diagnosis of the Tracheobronchial Invasion of Advanced Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Accurate diagnosis of the tracheobronchial invasion of advanced esophageal cancer is essential to select appropriate treatment and improve prognosis; however, it is difficult using the conventional modalities. This study aimed to clarify the diagnostic usefulness of convex probe endobronchial ultrasound (CP-EBUS) for the diagnosis of the tracheobronchial invasion of advanced esophageal cancer.

Methods

We conducted a cadaveric study to clarify the changes in ultrasonic and histopathologic findings in the esophageal tumor and tracheal invasion models. Additionally, we examined CP-EBUS for patients with advanced thoracic esophageal cancer in whom tracheobronchial invasion was suspected on contrast-enhanced computed tomography (CE-CT) scan. We retrospectivity evaluated the diagnosis of CP-EBUS, comparing the pathological findings and treatment outcomes.

Results

Cadaveric esophageal tumor and tracheal invasion models showed the disappearance of the third layer observed with CP-EBUS and histologically proven interruption of the adventitia. This indicated that the third layer corresponded with the tracheal adventitia. We examined 40 patients with advanced thoracic esophageal cancer in whom tracheobronchial invasion was suspected. The precise diagnosis was pathologically confirmed in 9 of 14 patients diagnosed with cT3 who underwent radical surgery. 20 of 26 cases diagnosed with cT4b received definitive chemoradiotherapy, and 4 cases received salvage surgery and pathologically confirmed precise diagnosis.

Conclusion

CP-EBUS is extremely useful for diagnosing the tracheobronchial invasion of advanced esophageal cancer. It could be an effective modality for determining treatment strategies in cases with a marginal surgical indication.

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References

  1. Gamliel Z, Krasna MJ. Multimodality treatment of esophageal cancer. Surg Clin North Am. 2005;85:621–30.

    Article  Google Scholar 

  2. Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019;17:855–83.

    Article  CAS  Google Scholar 

  3. Seto Y, Chin K, Gomi K, et al. Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci. 2007;98:937–42.

    Article  CAS  Google Scholar 

  4. Yamabe Y, Kuroki Y, Ishikawa T, et al. Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT. Am J Roentgenol. 2008;191:753–7.

    Article  Google Scholar 

  5. van Zoonen M, van Oijen MG, van Leeuwen MS, et al. Low impact of staging EUS for determining surgical resectability in esophageal cancer. Surg Endosc. 2012;26:2828–34.

    Article  Google Scholar 

  6. Tangoku A, Yamamoto Y, Furukita Y, et al. The new era of staging as a key for an appropriate treatment for esophageal cancer. Ann Thorac Cardiovasc Surg. 2012;18:190–9.

    Article  Google Scholar 

  7. Liberman M, Hanna N, Duranceau A, et al. Endobronchial ultrasonography added to endoscopic ultrasonography improves staging in esophageal cancer. Ann Thorac Surg. 2013;96:232–6.

    Article  Google Scholar 

  8. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.

    Article  Google Scholar 

  9. Yoshida T, Seike J, Miyoshi T, et al. Preoperative chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fl uorouracil for stage II/III squamous cell carcinoma of the esophagus. Esophagus. 2010;7:95–100.

    Article  Google Scholar 

  10. Picus D, Balfe DM, Koehler RE, et al. Computed tomography in the staging of esophageal carcinoma. Radiology. 1983;146:433–8.

    Article  CAS  Google Scholar 

  11. Hurter T, Hanrath P. Endobronchial sonography: fesibility and preliminary results. Thorax. 1992;47:565–7.

    Article  CAS  Google Scholar 

  12. Nishimura Y, Osugi H, Inoue K, et al. Bronchoscopic ultrasonography in the diagnosis of tracheobronchial invasion of esophageal cancer. J Ultrasound Med. 2002;21:49–58.

    Article  Google Scholar 

  13. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. Ann Thorac Surg. 2013;96:1502–7.

    Article  Google Scholar 

  14. Nakajima T, Yasufuku K, Yoshino I. Current status and perspective of EBUS-TBNA. Gen Thorac Cardiovasc Surg. 2013;61:390–6.

    Article  Google Scholar 

  15. Yasufuku K, Nakajima T, Fujiwara T, et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg. 2011;91:831–6.

    Article  Google Scholar 

  16. Xiayu F, Feixiang W, Xiaodong S, et al. Endobronchial ultrasound improves evaluation of recurrent laryngeal nerve lymph nodes in esophageal squamous cell carcinoma patients. Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-09241-8(publishedonline).

    Article  Google Scholar 

  17. Osugi H, Nishimura Y, Takemura M, et al. Bronchoscopic ultrasonography for staging supracarinal esophageal squamous cell carcinoma: impact on outcome. World J Surg. 2003;27:590–4.

    Article  Google Scholar 

  18. Lehr L, Rupp N, Siewert JR. Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging. Surgery. 1988;103:344–50.

    CAS  PubMed  Google Scholar 

  19. Riedel M, Stein H, Mounyam L, et al. Predictors of tracheobronchial invasion of suprabifurcal oesophageal cancer. Respiration. 2000;67:630–7.

    Article  CAS  Google Scholar 

  20. Hordjik ML, Zander H, van Blankenstein M, et al. Influence of tumor stenosis on the accuracy of endosonography. Endoscopy. 1993;25:171–5.

    Article  Google Scholar 

  21. Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2012. Esophagus. 2019;16:221–45.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan

    Takeshi Nishino MD, PhD, Hiroaki Toba MD, PhD, Takahiro Yoshida MD, PhD, Seiya Inoue MD, PhD, Masakazu Goto MD, PhD, Naoya Kawakita MD, PhD, Hiromitsu Takizawa MD, PhD & Akira Tangoku MD, PhD

  2. Department of Anatomy and Cell Biology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan

    Yoshihiro Tsuruo MD, PhD

Authors
  1. Takeshi Nishino MD, PhD
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  2. Hiroaki Toba MD, PhD
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  3. Takahiro Yoshida MD, PhD
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  4. Seiya Inoue MD, PhD
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  5. Masakazu Goto MD, PhD
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  6. Naoya Kawakita MD, PhD
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  7. Hiromitsu Takizawa MD, PhD
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  8. Yoshihiro Tsuruo MD, PhD
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  9. Akira Tangoku MD, PhD
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Correspondence to Hiroaki Toba MD, PhD.

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Nishino, T., Toba, H., Yoshida, T. et al. Endobronchial Ultrasound Improves the Diagnosis of the Tracheobronchial Invasion of Advanced Esophageal Cancer. Ann Surg Oncol 28, 6398–6406 (2021). https://doi.org/10.1245/s10434-021-09912-0

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  • DOI: https://doi.org/10.1245/s10434-021-09912-0

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