Therapeutic strategies for tumors of the esophagus and gastric cardia require precise preoperative staging.
Endosonography is considered the most accurate staging method. Computed tomography (CT) has limitations, especially in the evaluation of local infiltration.
Macroscopic endoscopic evaluation has also been reported to be accurate, but no study has compared all 3 of these modalities.
The research team prospectively staged 117 unselected patients with tumors of the esophagus and gastric cardia. Patients were first assessed by the endoscopic macroscopic appearance and then by endosonography. In addition, all patients had preoperative CT scans.
Only the 36 patients receiving the scans at the team's own institution were included in this study.
|Accuracy of predicting lymph node metastasis was greatest using endosonographic staging.|
The research team's findings are reported in the latest issue of Digestion.
The researchers compared preoperative staging results to postoperative histology. This was available as the gold standard in all included patients.
They used Kappa statistics to exclude the chance agreement of clinical staging results with the pathohistological findings.
The differences between the values for the different staging modalities were analyzed using a jack-knife test.
The research team found that endoscopic macroscopic staging and endosonography
were significantly more accurate than CT for determination of the T category. Results were 67%, 69% and 33%, respectively.
After the team excluded tumors of the cardia, the accuracy of macroscopic and endosonographic staging increased. These modalities remained more accurate than CT; 72%, 75% and 50%, respectively.
However, when staging of the T category, the team found that T2 tumors in the cardia were overestimated as T3 or even as T4 tumors, due to the inability to visualize the serosa.
The team determined that the accuracy of predicting lymph node metastasis was 68% for macroscopic endoscopic, 79% for endosonographic, and 67% for CT staging.
They determined that only endosonographic staging was significantly different from a chance agreement with the histology.
Dr Peter Kienleb's team concluded, "Endosonography is the most accurate staging modality for overall preoperative staging of esophageal and cardial tumors".
"Endoscopic macroscopic staging allows a reasonably accurate assessment of the T category."