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Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy—Results of a Multicenter Cohort Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC).

Methods

Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen's kappa statistics.

Results

For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: –/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen's kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients.

Conclusion

EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.

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Authors and Affiliations

  1. Department of Medicine B, Münster University Hospital, Münster, Germany

    Hauke Sebastian Heinzow, Sven Tsepetonidis, Wolfram Domschke, Dirk Domagk & Tobias Meister

  2. Department of Gastroenterology, University of Oldenburg, Oldenburg, Germany

    Hans Seifert

  3. Department of General and Visceral Surgery, Münster University Hospital, Münster, Germany

    Heiner Wolters

  4. Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany

    Torsten Kucharzik

  5. Department of Medicine II, HELIOS Albert-Schweitzer-Clinic, University Teaching Hospital, Sturmbäume 8-10, 37154, Northeim, Germany

    Tobias Meister

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  1. Hauke Sebastian Heinzow
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Correspondence to Tobias Meister.

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Author names in bold designate shared co-first authorship.

Dirk Domagk and Tobias Meister contributed equally as senior authors.

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Heinzow, H.S., Seifert, H., Tsepetonidis, S. et al. Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy—Results of a Multicenter Cohort Analysis. J Gastrointest Surg 17, 1050–1057 (2013). https://doi.org/10.1007/s11605-013-2189-2

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  • DOI: https://doi.org/10.1007/s11605-013-2189-2

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