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Klamt AL, Neyeloff JL, Santos LM, Mazzini GDS, Campos VJ, Gurski RR. Echoendoscopy in Preoperative Evaluation of Esophageal Adenocarcinoma and Gastroesophageal Junction: Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1657-1669. [PMID: 33896677 DOI: 10.1016/j.ultrasmedbio.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Esophageal adenocarcinomas of the esophagus and esophagogastric junction constitute a global health problem, the incidence of which has increased in recent decades. It has a poor prognosis and a low 5-year survival rate. Its treatment is based on preoperative clinical staging, in which echoendoscopy plays an essential role. The aim of this study was to evaluate the current accuracy of echoendoscopy in the staging of esophageal and esophogogastric junction adenocarcinomas. A systematic review was performed in PubMed, Embase and Portal BVS using the search terms Esophageal Neoplasm, Esophagus Neoplasms, Esophagus Cancers, Esophageal Cancers, EUS, EUS-FNA, Endoscopic Ultrasonography, Echo Endoscopy, Endosonographies and Endoscopic Ultrasound, with subsequent meta-analysis of the data found. The accuracy of tumor (T) staging was 65.55%. For T1, sensitivity was 64.7%, and specificity 89.1%, with an accuracy of 89.6%. For T2, sensitivity and specificity were 35.7% and 89.2%, respectively, with an accuracy of 87.1%. For T3, sensitivity and specificity were 82.5% and 83%, respectively, with an accuracy of 87%. For T4, sensitivity and specificity were 38.6% and 94%, respectively, with an accuracy of 66.4%. For node (N) staging, sensitivity was 77.3% and specificity 67.4%, with an accuracy of 77.9%. Echoendoscopy exhibits suboptimal accuracy in preoperative staging of esophageal adenocarcinoma and esophagogastric junction.
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Affiliation(s)
- Alexandre Luis Klamt
- Gastroenterology Service of the Hospital de Clínicas de Porto Alegre (HCPA), Graduate Program in Medicine: Surgical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil.
| | - Jeruza Lavanholi Neyeloff
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Letícia Maffazzioli Santos
- Radiology Service of the Hospital de Clínicas de Porto Alegre (HCPA), Graduate Program in Medicine: Surgical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Guilherme da Silva Mazzini
- Digestive Tract Surgery Service of the Hospital de Clínicas de Porto Alegre (HCPA), Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Vinicius Jardim Campos
- Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
| | - Richard Ricachenevsky Gurski
- Digestive Tract Surgery Service and Surgery Group of the Esophagus and Stomach of the Hospital de Clínicas de Porto Alegre (HCPA), Port Alegre, Rio Grande do Sul, Brazil; Department of Surgery, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Port Alegre, Rio Grande do Sul, Brazil
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Jones CM, Lyles A, Foley KG. A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK. Clin Radiol 2021; 76:458-464. [PMID: 33752881 DOI: 10.1016/j.crad.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 01/01/2023]
Abstract
AIM To evaluate variation in the pre-pandemic use of endoscopic ultrasound (EUS) for oesophageal cancer diagnosis and treatment planning up to 2019, and which factors contributed to this. MATERIALS AND METHODS A UK-wide online survey of oesophagogastric multidisciplinary team lead clinicians was undertaken to determine perceptions towards, and the use of, EUS to aid staging and treatment planning in oesophageal cancer. RESULTS Thirty-five responses were received, representing 97 UK National Health Service Trusts/Health Boards. A majority of centres (n=21, 60%) did not have formal written guidance for EUS use. Although all respondents had access to EUS, a perceived lack of utility (n=7) and concerns about delaying treatment start dates (n=8) each restricted EUS use for a fifth of respondents. For most centres (n=24, 68.6%), EUS use is case-specific, whereas for 10 (28.6%) EUS is used for all patients with potentially curable disease. A majority of centres use diagnostic positron-emission tomography for radiotherapy target volume delineation (TVD), whereas 22 (62.9%) use EUS. The factors contributing to decisions to use EUS for staging, TVD and surgical planning varied between centres. The proportion of centre respondents who would request EUS in each of six clinical scenarios varied considerably. CONCLUSION There were substantial differences in the patient and disease characteristics that are perceived to be indications for EUS use for both staging and treatment planning. Research to clarify in which patients with oesophageal cancer EUS affords benefit is required, as is urgent standardisation of its role in the diagnostic pathway.
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Affiliation(s)
- C M Jones
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
| | - A Lyles
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K G Foley
- Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK
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Affiliation(s)
- Sri G Thrumurthy
- Department of Surgery, Epsom and St Helier University Hospitals, Sutton SM5 1AA, UK
- Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, UK
| | - M Asif Chaudry
- Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, UK
| | | | - Muntzer Mughal
- Department of Surgery, University College Hospital London, London, UK
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James PD, Hegagi M, Antonova L, Tinmouth J, Heitman SJ, Simone C, Yeung E, Yong E. Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study. CMAJ Open 2017; 5:E437-E443. [PMID: 28600449 PMCID: PMC5498178 DOI: 10.9778/cmajo.20160153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. METHODS We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. RESULTS We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas. INTERPRETATION Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs- and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province.
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Affiliation(s)
- Paul D James
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Mae Hegagi
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Lilia Antonova
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Jill Tinmouth
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Steven J Heitman
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Carmine Simone
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yeung
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yong
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
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DaVee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer? World J Gastroenterol 2017; 23:751-762. [PMID: 28223720 PMCID: PMC5296192 DOI: 10.3748/wjg.v23.i5.751] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/23/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.
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Leng XF, Zhu Y, Wang GP, Jin J, Xian L, Zhang YH. Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis 2016; 8:2146-57. [PMID: 27621871 DOI: 10.21037/jtd.2016.07.71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal cancer is considered a serious malignancy with respect to its prognosis and mortality rate. Cervical lymph node status is one of the keys to determining prognosis and treatment methods. However, published data vary regarding the accuracy of ultrasound in the diagnosis of cervical lymph node metastasis. We performed a meta-analysis to assess the efficacy of ultrasound for detecting cervical lymph node metastasis in patients with esophageal cancer. METHODS The PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched to identify studies related to cervical lymph node metastasis, and 22 studies comprising 3,513 patients met our inclusion criteria. We used a bivariate meta-analysis following a random effects model to summarize the data. We also explored reasons for statistical heterogeneity using meta-regression, subgroup, and sensitivity analyses. Publication bias was assessed with a Deeks funnel plot. RESULTS The area under the receiver operating characteristic curve was 0.97 [95% confidence interval (CI): 0.95-0.98], and the pooled diagnostic odds ratio was 121.00 (95% CI: 47.57-307.79). With cut-off values of 5 mm and >5 mm for cervical lymph node size, the sensitivities and specificities (95% confidence interval) for ultrasound detection of cervical lymph node metastasis were 84% (67-93%) and 93% (90-95%); and 94% (76-98%) and 98% (89-100%), respectively. CONCLUSIONS We show for the first time the diagnostic accuracy of ultrasound for predicting cervical lymph node-positive metastasis in esophageal cancer. Our analysis shows that ultrasonography may be an effective and reliable approach to detect cervical lymph node metastasis in esophageal cancer. However, to accommodate heterogeneity, high-quality studies are needed to further verify the efficacy of ultrasound detection.
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Affiliation(s)
- Xue-Feng Leng
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Yi Zhu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Ge-Ping Wang
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Jian Jin
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lei Xian
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yu-Hong Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg 2013; 37:147-55. [PMID: 23015224 DOI: 10.1007/s00268-012-1804-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In esophageal cancer patients preoperative staging will determine the type of surgical procedure and use of neoadjuvant therapy. Tumor location and lymph node status play a pivotal role in this tailored strategy. The aim of the present study was to prospectively evaluate the accuracy of preoperative assessment of tumor location according to the Siewert classification and lymph node status per station with endoscopy/endoscopic ultrasound (EUS) and computed tomography (CT). METHODS In 50 esophagectomy patients with adenocarcinoma of the gastroesophageal junction (GEJ), tumor location according to Siewert and N-stage per nodal station as determined preoperatively by endoscopy/EUS and CT were compared with the histopathologic findings in the resection specimen. RESULTS Overall accuracy in predicting tumor location according to the Siewert classification was 70 % for endoscopy/EUS and 72 % for CT. Preoperative data could not be compared with the pathologic assessment in 11 patients (22 %), as large tumors obscured the landmark of the gastric folds. The overall accuracy for predicting the N-stage in 250 lymph node stations was 66 % for EUS and 68 % for CT. The accuracy was good for those stations located high in the thorax, but poor for celiac trunk nodes. CONCLUSIONS Given the frequent discrepancy between the endoscopic and pathologic location of the GEJ and the common problem of advanced tumors obscuring the landmarks used in the assessment of the Siewert classification, its usefulness is limited. The overall accuracy for EUS and CT in predicting the N-stage per station was moderate.
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Luna RA, Gilbert E, Hunter JG. High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus: the role of esophagectomy in the era of endoscopic eradication therapy. Curr Opin Gastroenterol 2012; 28:362-9. [PMID: 22517568 DOI: 10.1097/mog.0b013e328353e346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate the role of esophagectomy for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in light of recent advances in endoscopic therapy for Barrett's esophagus. RECENT FINDINGS Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are proven well tolerated and effective, at least in midterm follow-up. The application of these techniques has opened a new road for the local treatment of esophageal HGD and IMC. To safely employ these techniques, reliable and accurate staging of the esophageal neoplasm is essential. EMR has taken a central role, as it allows the pathologist to provide tumor-staging information necessary for an appropriate clinical management decision process. Unfortunately, both RFA and EMR have limitations that preclude their universal use in the treatment of early esophageal cancer. In some cases, esophagectomy still remains the best treatment option. The evolution of the minimally invasive approach to esophagectomy may improve outcomes of this major operation. SUMMARY A better understanding of the indications and limitations of endoscopic therapy for HGD and IMC permits a tailored approach to the management of patients with early esophageal adenocarcinoma. When indicated, the selection of a less morbid surgical technique has the potential to improve overall surgical and oncological outcomes.
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Affiliation(s)
- Renato A Luna
- Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA
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Levels of evidence in endoscopic ultrasonography: a systematic review. Dig Dis Sci 2012; 57:602-9. [PMID: 22057240 DOI: 10.1007/s10620-011-1961-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/20/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS A prolific trend currently designates endoscopic ultrasonography (EUS) literature. We aimed to record all EUS-studies published during the past decade and evaluate them in terms of scientific quality, creating a stratification based on levels of evidence (LE). METHODS All articles on EUS published between January 2001 and December 2010 were retrieved using a Pubmed and Cochrane Library search. Inclusion criteria were: original research papers (randomized controlled trials-RCTs, prospective and retrospective studies), meta-analyses, reviews and surveys pertinent to gastrointestinal EUS. Levels of evidence (LE) were assessed using the North of England evidence-based guidelines. RESULTS Overall, 1,832 eligible articles were reviewed. The majority (46.1%) of reports comprised retrospective descriptive studies (LE III). Expert reviews and committee reports (LE IV) accounted for 28.9%, well-designed quasi-experimental studies (LE IIb) for 20.1%, RCTs (LE Ib) for 2.4%, prospective controlled trials (LE IIa) for 1.4%, and meta-analyses (LE Ia) for 1.1% of the total. High LE (Ia-Ib) were assigned to loco-regional staging of luminal gastrointestinal cancers; mediastinal staging of lung cancer; diagnostic work-up of solid pancreatic tumors, suspected biliary obstruction and choledocholithiasis; celiac plexus neurolysis; and pancreatic pseudocysts drainage. Intermediate to low LE (IIa-IV) were assigned to submucosal tumors, pancreatic cysts, chronic pancreatitis and novel therapeutic applications (pancreato-biliary drainage, tumor ablation). CONCLUSIONS Diagnostic and staging EUS has matured and has proven its clinical impact on patient management. Therapeutic or interventional EUS is still evolving and more quality research and data are needed to establish EUS as the best next intervention to perform once firm evidence is available.
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Dilation of malignant strictures in endoscopic ultrasound staging of esophageal cancer and metastatic spread of disease. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:356538. [PMID: 22203779 PMCID: PMC3235661 DOI: 10.1155/2011/356538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/30/2011] [Accepted: 10/04/2011] [Indexed: 12/15/2022]
Abstract
Background. Dilation of malignant strictures in endoscopic ultrasound (EUS) staging of esophageal cancer is safe, but no data exists regarding the subsequent development of metastases. Aim. Compare the rates of metastases in esophageal cancer patients undergoing EUS staging who require esophageal dilation in order to pass the echoendoscope versus those who do not. Methods. We reviewed consecutive patients referred for EUS staging of esophageal cancer. We evaluated whether dilation was necessary in order to pass the echoendoscope, and for the subsequent development of metastases after EUS at various time intervals. Results. Among all patients with similar stage (locally advanced disease, defined as T3, N0, M0 or T1-3, N1, M0), there was no difference between the dilated and nondilated groups in the rates of metastases at 3 months (14% versus 10%), P = 1.0, 6 months (28% versus 20%), P = 0.69, 12 months (43% versus 40%), P = 1.0, or ever during a mean followup of 15 months (71% versus 55%), P = 0.48. Conclusions. Dilation of malignant strictures for EUS staging of esophageal cancer does not appear to lead to higher rates of distant metastases.
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Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer. Surg Endosc 2009; 24:1380-6. [PMID: 20033712 DOI: 10.1007/s00464-009-0783-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 11/12/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has been a useful method for the accurate staging of esophageal cancer. This study aimed to compare the diagnostic performance of EUS, positron emission tomography (PET), and computed tomography (CT) in the locoregional staging of resectable esophageal cancer. METHODS A total of 109 patients with resectable esophageal cancer were prospectively enrolled and retrospectively reviewed for evaluation of preoperative EUS, PET, and CT. The sensitivity, specificity, and accuracy of tumor depth (T) staging and regional lymph nodal (N) staging for each test were compared with the postoperative histopathologic stage as the gold standard. RESULTS The overall accuracy of EUS for T staging was 72%, and it was the only method for delineating the layers of the esophageal wall. The sensitivities for N staging were 42% for EUS, 49% for PET, and 35% for CT, and their specificities were, respectively, 91, 87, and 93%. The accuracy for N staging was 66% for EUS, 68% for PET, and 63% for CT, and it did not differ significantly across the three tests. CONCLUSIONS Preoperative EUS for the locoregional staging of esophageal cancer provides excellent T staging accuracy and similar accuracy for N staging compared with PET and CT. Especially in T staging, EUS could play an important role in the choice of candidates for esophageal cancer surgery.
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12
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Polkowski M. Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23:649-61. [PMID: 19744630 DOI: 10.1016/j.bpg.2009.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 05/26/2009] [Indexed: 02/07/2023]
Abstract
Numerous studies conducted over the last 25 years provide evidence on the high diagnostic accuracy and important role of endoscopic ultrasonography (EUS) in staging oesophageal and gastric carcinoma. This extensive research was recently subjected to metaanalyses, condensing our knowledge on EUS performance and facilitating its comparison with competing methods. It is, however, important to realise that the management of oesophageal and gastric carcinoma is evolving and so are staging algorithms, setting new challenges for EUS and re-defining its position. Restaging after neoadjuvant treatment and precise assessment of early carcinoma before endoscopic treatment are areas of growing interest, but the role of EUS in these settings is rather limited. Rapidly developing cross-sectional imaging has the potential to challenge the position of EUS as the most accurate method in loco-regional staging. On the other hand, EUS guided fine-needle aspiration offers the unique opportunity to obtain cytological confirmation of lymph node metastases, with future potential for molecular staging.
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Affiliation(s)
- M Polkowski
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland.
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Peters CJ, Hardwick RH, Vowler SL, Fitzgerald RC. Generation and validation of a revised classification for oesophageal and junctional adenocarcinoma. Br J Surg 2009; 96:724-33. [PMID: 19526624 DOI: 10.1002/bjs.6584] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oesophageal adenocarcinoma is the commonest oesophageal malignancy in the West, but is staged using a system designed for squamous cell carcinoma. The aim was to develop and validate a staging system for oesophageal and junctional adenocarcinoma. METHODS Patients with oesophageal adenocarcinoma (Siewert types I and II) undergoing oesophagectomy with curative intent were randomly assigned to generation (313 patients) and validation (131) data sets. Outcome in the generation data set was associated with histopathological features; a revised node (N) classification was derived using recursive partitioning and tested on the validation data set. RESULTS A revised N classification based on number of involved lymph nodes (N0, none; N1, one to five; N2, six or more) was prognostically significant (P < 0.001). Patients with involved nodes on both sides of the diaphragm, regardless of number, had the same outcome as the N2 group. When applied to the validation data set, the revised classification (including nodal number and location) provided greater discrimination between node-positive patients than the existing system (P < 0.001). CONCLUSION A revised N classification based on number and location of involved lymph nodes provides improved prognostic power and incorporates features that may be useful before surgery in clinical management decisions.
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Affiliation(s)
- C J Peters
- Medical Research Council (MRC) Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge, UK
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Abstract
Esophageal malignancy is a major source of morbidity and mortality, despite the recently increased attention to screening and early detection. Prognosis for esophageal cancer remains grim, with advanced tumor stage and lymph node metastases conferring even graver outcomes. Several studies have demonstrated that the addition of preoperative neoadjuvant chemoradiotherapy may improve survival in patients with locally advanced tumor (T3) disease or local lymph node metastases. It is here that endoscopic ultrasonography finds its niche in the precise staging of these tumors and the subsequent use of stage-dependent treatment protocols.
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Affiliation(s)
- Alan Brijbassie
- Carilion Clinic, 3113-G Honeywood Lane, Roanoke, VA 24018, USA
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