Computed tomography(CT) and endoscopic ultrasound are part of the regular staging protocol in esophageal cancer.
The value of the 2 methods was assessed in patients with early cancer in Barrett's esophagus.
Dr Oliver Pech and colleagues from Germany evaluated 100 consecutive patients with a median age of 64 years.
The investigators assigned patients with suspected early cancer in Barrett's to a standardized staging program with upper gastrointestinal endoscopy.
Endoscopic ultrasound, computed tomography of the chest and upper abdomen, and abdominal ultrasonography were performed.
The investigators summarized the results in accordance with the tumor node metastases classification.
|Sensitivity of endoscopic ultrasound for N staging was 75%|
|American Journal of Gastroenterology|
On the basis of the lymph node findings on computed tomography and/or endoscopic ultrasound, the patients were assigned to 3 categories.
Patients in category 1 had no suspicious lymph nodes.
The investigators assigned patients with paraesophageal lymph nodes less than 1 cm in size at the tumor level to category 2.
These patients also had lymph nodes more than 1 cm in size not at the tumor level in the mediastinum or celiac trunk.
In category 3, the team included patients with paraesophageal lymph nodes more than 1 cm in size at the tumor level.
The endoscopic ultrasound and computed tomography findings were checked every 6 months in patients who underwent endoscopic treatment.
The investigative team scheduled surgical resection in operable patients if staging showed a T category higher than T1.
The team also undertook surgical resection in patients where the lymph node staging was assessed according to the classification of category 3.
Patients with suspected submucosal infiltration underwent diagnostic endoscopic resection.
If submucosal involvement was confirmed, the patients were referred for surgery.
The investigators reported that the median follow-up period was 25 months.
The T category diagnosed with computed tomography was T1 or less in all patients.
On endoscopic ultrasound, the T category was classified as T1 in 92% of cases, and as more than T1 in 8%.
The investigators detected enlarged lymph nodes in 45% of the patients.
The investigative team diagnosed significantly more category 2 lymph nodes with endoscopic ultrasound than computed tomography.
The team identified lymph nodes at the level with the highest suspicion, in category 3, using computed tomography in only 3 of 9 cases.
Sensitivity of computed tomography for N staging was 38% compared with 75% for endoscopic ultrasound.
The investigators found no extranodal metastases on computed tomography.
Dr Pech's team concludes, “In suspected early cancer in Barrett's esophagus, endoscopic ultrasound is superior to computed tomography for T staging and N staging.”
“Computed tomography had no influence on the tumor node metastases classification in any of these patients.”
“It may therefore be possible to dispense with this method as a staging procedure in patients with cancer in Barrett's esophagus.”
“By contrast, endoscopic ultrasound is required in order to differentiate between patients with cancer in Barrett's esophagus in whom endoscopic therapy is suitable and those in whom surgical treatment is required.”