A team from Philadelphia, Pennsylvania, USA, assessed the accuracy of endoscopic ultrasound (EUS) in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma.
EUS was performed in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma based on endoscopy, endoscopic biopsies, and CT before esophagectomy.
EUS findings were compared with surgical/pathologic evaluation.
The researchers found that EUS suggested submucosal invasion in 6 patients and lymph node involvement in 5 patients.
By surgical/pathologic evaluation, 5 of 22 patients (23%) had unsuspected submucosal invasion and 1 had lymph node involvement. EUS detected all 5 instances of submucosal invasion and the single instance of lymph node involvement.
| Sensitivity and specificity of EUS were high.
| Gastrointestinal Endoscopy |
It was found that EUS was falsely positive for submucosal invasion in 1 patient and for lymph node involvement in 4 patients.
Sensitivity, specificity, and negative predictive values of preoperative EUS for submucosal invasion were 100%, 94%, and 100%, respectively. For lymph node involvement, the values were 100%, 81%, and 100%, respectively.
A nodule or stricture noted by endoscopy was associated with an increased likelihood of submucosal invasion.
Dr Ilias A. Scotiniotis, of the Hospital of the University of Pennsylvania, Philadelphia, said on behalf of fellow authors, "In patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma, EUS detected otherwise unsuspected submucosal invasion and lymph node involvement.
"Patients should be evaluated with EUS when nonoperative therapy is contemplated," it was concluded.