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Ann Thorac Surg 1999;67:1466-1469
© 1999 The Society of Thoracic Surgeons

Original Articles

Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy

Ernesto Laterza, MDa, Giovanni de Manzoni, MDa, Alfredo Guglielmi, MDa, Luca Rodella, MDa, Pietro Tedesco, MDa, Claudio Cordiano, MDa

a First Division of General Surgery, University of Verona, Verona, Italy

Accepted for publication December 4, 1998.

Address reprint requests to Dr de Manzoni, 1st Department of General Surgery, Borgo Trento Hospital, Piazza Stefani 1, 37126 Verona, Italy

Background. In past years multimodal neoadjuvant treatment for carcinoma of the esophagus has been used with increased frequency. Staging of the neoplasm still remains fundamental in evaluating the response to therapy and in planning operation. The aim of the present study was to assess the accuracy of endoscopic ultrasonography (EUS) in a group of patients with squamous cell carcinoma of the thoracic esophagus after undergoing radiotherapy and chemotherapy.

Methods. Among a group of 111 patients with squamous cell carcinoma of the thoracic esophagus and treated with preoperative radiotherapy and chemotherapy, 87 were operated. In these patients it was possible to compare the results of EUS, with regard to depth of invasion of esophageal wall (T) and lymph node involvement (N), with the results of operation and histopathologic study.

Results. Feasibility of EUS before and after neoadjuvant treatment was 71.2% and 83.9%, respectively. The overall accuracy of EUS regarding the wall invasion was 47.9%. The more frequent error was overstaging, especially in patients with complete response and in patients with minimal residual disease. In the assessment of lymph node involvement, EUS showed an overall accuracy of 71.2% with a moderate {kappa} value. Sensitivity for N1 and N0 was 73.7% and 68.6%, respectively.

Conclusions. Endoscopic ultrasonography was feasible in most patients after preoperative radiotherapy and chemotherapy, but our study documented a worsening of accuracy of EUS in the evaluation of T attributable to the confounding presence of radiation fibrosis and soft tissue reaction after radiotherapy and chemotherapy.




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