N-staging of oesophageal and junctional carcinoma: Is there still a role for EUS in patients staged N0 at PET/CT?

Aim To assess whether separate endoscopic ultrasound (EUS) lymph node (N)-staging is still of prognostic value in those staged node negative (N0) at combined positron-emission tomography/computed tomography (PET/CT) in patients with oesophageal cancer (OC). Materials and methods One hundred and seve...

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Published in:	Clinical radiology 2014-09, Vol.69 (9), p.959-964
Main Authors:	Foley, K.G, Lewis, W.G, Fielding, P, Karran, A, Chan, D, Blake, P, Roberts, S.A
Format:	Article
Language:	eng
Subjects:	Adenocarcinoma - diagnostic imaging Adenocarcinoma - mortality Adenocarcinoma - pathology Aged Carcinoma, Squamous Cell - diagnostic imaging Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophagogastric Junction - diagnostic imaging Esophagogastric Junction - pathology Female Humans Kaplan-Meier Estimate Lymph Nodes - pathology Male Neoplasm Staging Positron-Emission Tomography Prognosis Radiology Reproducibility of Results Tomography, X-Ray Computed
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Summary:	Aim To assess whether separate endoscopic ultrasound (EUS) lymph node (N)-staging is still of prognostic value in those staged node negative (N0) at combined positron-emission tomography/computed tomography (PET/CT) in patients with oesophageal cancer (OC). Materials and methods One hundred and seventeen consecutive patients [median age 67 years; 88 male; 98 cases of adenocarcinoma, 19 cases of squamous cell carcinoma (SCC)] staged as N0 at PET/CT underwent EUS to record tumour (T)- and N-stage. The patients were subsequently separated into two groups: EUS N0 ( n = 78) and EUS N+ ( n = 39). Survival analysis using Kaplan–Meier and Cox's proportional hazard methods was performed. Primary outcome was overall survival from diagnosis. Results EUS N-stage and EUS N0 versus EUS N+ ( p = 0.005 and p = 0.001, respectively) were found to be significantly and independently associated with survival in two models of multivariate analysis, in patients staged N0 at PET/CT. EUS T-stage was significantly associated with survival on univariate analysis. Conclusion EUS N-staging still has prognostic value in patients staged N0 at PET/CT. There is a significant difference in survival between EUS N0 and positive nodal EUS status in those staged N0 at PET/CT, suggesting PET/CT is unreliable for local staging. PET/CT and EUS continue to have complimentary roles in OC staging.
ISSN:	0009-9260 1365-229X