Application of miniprobe sonography in the local staging of earlier stage upper gastrointestinal epithelial neoplasm: A four‐year experience in a single center. Issue 1 (24th August 2018) - Hsu, Wen‐Hung
Abstract : Miniprobe endoscopic ultrasound (miniprobe EUS) has been used as the staging tool in upper gastrointestinal neoplasms, including esophageal cancer and gastric cancer. Staging results have a strong impact on the decision as to whether a patient should undergo endoscopic treatment, surgery alone, or neoadjuvant therapy. This retrospective study was conducted to analyze the accuracy of miniprobe EUS in staging of gastric cancer and esophageal cancer. From January 2007 to August 2011, 71 patients who underwent EUS with 12‐MHz miniprobe for staging of esophageal cancer or gastric cancer before endoscopic submucosal dissection or surgical esophagectomy, or gastrectomy plus lymphadenectomy, were included. Seventy‐one consecutive patients, 35 with esophageal cancer and 36 with gastric cancer, were included in this study. In the 35 esophageal cancer cases, 22 patients underwent surgical esophagectomy plus lymphadenectomy and 13 patients underwent endoscopic submucosal dissection. Postoperatively, 20 patients were staged as having T1 cancers (57.1%), eight patients T2 (22.9%), six patients T3 (17.1%), and one patient T4 (2.9%). The accuracy of miniprobe EUS to the T stage was 91.4% for T1, 71.4% for T2, 80% for T3, and 82.9% for T4, respectively. Positive lymph nodes were diagnosed histologically in four patients among 22 extensive esophagectomy patients (18.2 %). The accuracy of miniprobe EUS for the diagnosis of lymph node was 50% for esophageal cancer. Among the 36 gastric cancer patients, 32 underwent surgical gastrectomy plus D2 lymphadenectomy and four underwent endoscopic submucosal dissection. Postoperatively, 24 patients were staged as having T1 cancers (66.7%), nine patients T2 (25.0%), two patients T3 (5.6%), and one patient T4 (2.7 %). The accuracy of miniprobe EUS relative to the T stage was 66.7% for T1, 55.6% for T2, 91.7% for T3, and 97.2% for T4, respectively. Positive lymph nodes were diagnosed histologically in eight patients among 32 gastrectomy plus lymphadenectomy. The accuracy of miniprobe EUS for the diagnosis of lymph node was 61% for gastric cancer. The diagnostic accuracy of miniprobe EUS in patients with esophageal cancer was reliable in T1 cancer. However, the lymph node was frequently overstaged. In gastric cancer, the overall accuracy of T‐staging was lower than esophageal cancer and frequently overstaged. Besides, gastric metastatic lymph node was easily missed by miniprobe EUS.