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4 - Endoscopic Ultrasound in Esophageal Cancer

Published online by Cambridge University Press:  08 August 2009

Anne Marie Lennon
Affiliation:
Specialist Registrar, Lothian University Hospitals Division, Western General Hospital, Edinburgh
Ian D. Penman
Affiliation:
Consultant Gastroenterologist, Lothian University Hospitals Division, Western General Hospital, Edinburgh
Sheila C. Rankin
Affiliation:
Guy's and St Thomas' Hospital
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Summary

Introduction

The major role for endoscopic ultrasound (EUS) is in defining stage of disease. Tumors are staged using the TNM classification, which describes the anatomic extent of cancer at the time of diagnosis and before therapy (Table 4.1). This allows a classification of the stages of cancer for estimation of prognosis and comparing the results of different treatments (Table 4.2). The definitions of TNM are based on the depth of invasion of the tumor into the esophageal wall or beyond (T stage), the presence or absence of regional lymph node involvement (N stage), and identification of distant metastasis (M stage). EUS provides uniquely detailed images of the different layers of the esophagus and surrounding structures. Using standard EUS (5–12 MHz), the esophageal wall is visualized as five layers that correspond to the mucosa (layers 1 and 2), submucosa (layer 3), muscularis propria (layer 4), and the outer, adventitial layer (layer 5) (Figure 4.1).

T staging

Tis is the earliest stage, defined as tumor present in the epithelium but not invading the lamina propria. T1 tumors involve the lamina propria and the submucosa. These can be further subclassified as T1 m where the tumor is confined to the mucosa and T1sm where the tumor invades the submucosa (Figure 4.2). Tumors that invade the muscularis propria are classified as T2 (Figure 4.4), while tumors involving the adventitia are termed T3 (Figure 4.4). Involvement of mediastinal structures such as the pleura, azygous vein, aorta, or adjacent structures indicates T4 disease (Figure 4.5).

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Publisher: Cambridge University Press
Print publication year: 2007

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References

American Joint Committee on Cancer. AJCC Cancer Staging Manual. (Philadelphia, PA: Lippincott-Raven, 2001), 91–8.
Vilgrain, V., Mompoint, D., Palazzo, L., et al. Staging of oesophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR Am J Roentgenol, 155 (1990), 277–81.CrossRefGoogle Scholar
Rosch, T.. Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin N Am, 5 (1995), 537–47.Google ScholarPubMed
Botet, J., Lightdale, C. J., Zauber, G., et al. Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT. Radiology, 181 (1991), 419–25.CrossRefGoogle ScholarPubMed
Lightdale, C. and Kulkarni, K. G.. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol, 20 (2005), 4483–9.CrossRefGoogle Scholar
Vazquez-Sequeiros, E., Norton, I. D., Clain, J. E., et al. Impact of endoscopic ultrasound guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc, 53 (2001), 751–7.CrossRefGoogle Scholar
Holscher, A., Bollschweiler, E., Schneider, P. M., et al. Early adenocarcinoma in Barrett's oesophagus. Br J Surg, 84 (1997), 1470–3.CrossRefGoogle ScholarPubMed
Berger, A. and Scott, W. J.. Noninvasive staging of esophageal carcinoma. J Surg Res, 117 (2004), 127–33.CrossRefGoogle ScholarPubMed
Falk, G., Catalano, M. F., Sivak, M. V. Jr., et al., Endosonography in the evaluation of patients with Barrett's esophagus and high-grade dysplasia. Gastrointest Endosc, 40 (1994), 207–12.CrossRefGoogle ScholarPubMed
Canto, M.. Barrett's esophagus. Gastrointest Endosc Clin N Am, 15 (2005), 83–92.CrossRefGoogle ScholarPubMed
Hasegawa, N., Niwa, Y., Arisawa, T., et al. Preoperative staging of superficial esophageal carcinoma: comparison of an ultrasound probe and standard endoscopic ultrasonography. Gastrointest Endosc, 44 (1996), 388–93.CrossRefGoogle ScholarPubMed
Menzel, J., Hoepffner, N., Nottberg, H., et al. Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study. Endoscopy, 31 (1999), 291–7.CrossRefGoogle Scholar
Vazquez-Sequeiros, E. and Wiersema, M. J.. High-frequency US catheter-based staging of early esophageal tumors. Gastrointest Endosc, 55 (2002), 95–9.CrossRefGoogle ScholarPubMed
Fukuda, M., Hirata, K., Natori, H., et al. Endoscopic ultrasonography of the esophagus. World J Surg, 24 (2000), 216–26.CrossRefGoogle ScholarPubMed
Hunerbein, M., Ghadimi, B. M., Haensch, W., et al. Transendoscopic ultrasound of esophageal and gastric cancer using miniaturized ultrasound catheter probes. Gastrointest Endosc, 48 (1998), 371–5.CrossRefGoogle ScholarPubMed
Murata, Y., Suzuki, S., Ohta, M., et al. Endoscopic ultrasonography in diagnosis of esophageal carcinoma. Surg Endosc, 1 (1996), 11–16.CrossRefGoogle Scholar
Kawano, T., Ohshima, M., and Iwai, T.. Early esophageal carcinoma: endosopic ultrasonography using the Sonoprobe. Abdom Imaging, 28 (2003), 477–85.CrossRefGoogle Scholar
Nesje, L., Svanes, K., Viste, A., et al. Comparison of a linear miniature ultrasound probe and a radial scanning echoendoscope in TN staging of esophageal cancer. Scand J Gastroenterol, 35 (2000), 997–1002.Google Scholar
Yanai, H., Yoshida, T., Harada, T., et al. Endoscopic ultrasonography of superficial esophageal cancers using a thin ultrasound probe system equipped with switchable radial and linear scanning modes. Gastrointest Endosc, 44 (1996), 578–82.CrossRefGoogle ScholarPubMed
Wallace, M., Hoffman, B. J., Sahai, A. S., et al. Imaging of esophageal tumors with a water-filled condom and a catheter US probe. Gastrointest Endosc, 51 (2000), 597–600.CrossRefGoogle Scholar
Menzel, J. and Domschke, W.. Gastrointestinal miniprobe sonography: the current status. Am J Gastroenterol, 95 (2000), 605–16.CrossRefGoogle ScholarPubMed
Newnham, A., Quinn, M. J., Babb, P., et al. Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999. Aliment Pharmacol Ther, 17 (2003), 655–64.CrossRefGoogle ScholarPubMed
Pfau, P., Ginsberg, G. G., Lew, R. J., et al. EUS predictors of long-term survival in esophageal carcinoma. Gastrointest Endosc, 53 (2001), 463–9.CrossRefGoogle ScholarPubMed
Rizk, N., Venkatraman, E., Park, B., et al. The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer staging system. J. Thorac. Cardiovasc. Surg, 132 (2006), 1374–81.CrossRefGoogle ScholarPubMed
Roder, J., Busch, R., Stein, H. J., et al. Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the esophagus. Br J Surg, 81 (1994), 410–13.CrossRefGoogle Scholar
Natsugoe, S., Yoshinaka, H., Shimada, M., et al. Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma. Ann Surg, 234 (2001), 613–18.CrossRefGoogle ScholarPubMed
Killinger, W., Rice, T. W., Adelstein, D. J., et al. Stage II esophageal carcinoma: the significance of T and N. J Thorac Cardiovasc Surg, 111 (1996), 935–40.CrossRefGoogle Scholar
Catalano, M., Sivak, M. V. Jr., Rice, T., et al. Endosonographic features predictive of lymph node metastases. Gastrointest Endosc, 40 (1994), 442–6.CrossRefGoogle Scholar
Bhutani, M., Hawes, R. H., and Hoffman, B. J.. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc, 45 (1997), 474–9.CrossRefGoogle ScholarPubMed
Kelly, S., Harris, K. M., Berry, E., et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut, 49 (2001), 534–9.CrossRefGoogle ScholarPubMed
Vazquez-Sequeiros, E., Wiersema, M. J., Clain, J. E., et al. Impact of lymph node staging on therapy of esophageal carcinoma. Gastoenterology, 125 (2003), 1626–35.CrossRefGoogle ScholarPubMed
Tio, T., Cohen, P., Coene, P. P., et al. Endosonography and computed tomography of oesophageal carcinoma: preoperative classification compared to the new 1987 TNM system. Gastoenterology, 96 (1989), 1478–86.CrossRefGoogle Scholar
Rice, T., Boyce, G. A., and Sivak, J. M. V. Jr. Esophageal ultrasound and the preoperative staging of carcinoma of the esophagus. J Thorac Cardiovasc Surg, 101 (1991), 536–43.Google ScholarPubMed
Dittler, H. and Siewert, J. R.. Role of endoscopic ultrasonography in esophageal carcinoma. Endoscopy, 25 (1993), 156–61.CrossRefGoogle ScholarPubMed
Flamen, P., Lerut, A., Cutsem, E., et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol, 18 (2000), 3203–10.CrossRefGoogle ScholarPubMed
Choi, J., Lee, K. H., Shim, Y. M., et al. Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET. J Nucl Med, 41 (2000), 808–15.Google ScholarPubMed
Rasanen, J., Sihvo, F. I., Knuuti, M. J., et al. Prospective analysis of accuracy of PET, CT and EUS in staging of adenocarcinoma of the esophagus and gastroesophageal cancer. Ann Surg Oncol, 10 (2003), 954–60.CrossRefGoogle Scholar
Vazquez-Sequeiros, E., Levy, M. J., Clain, J. E., et al. Routine vs. selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma. Gastrointest Endosc, 63 (2006), 204–11.CrossRefGoogle ScholarPubMed
Reed, C., Mischra, G., Sahai, A. V., et al. Esophageal cancer staging: improved accuracy by endoscopic ultrasound in coeliac lymph nodes. Ann Thorac Surg, 67 (1999), 319–22.CrossRefGoogle Scholar
Eloubeidi, M., Wallace, M. B., Reed, C. E., et al. The utility of EUS and EUS-guided fine needle aspiration in detecting coeliac lymph node metastasis in patients with esophageal cancer: a single-center experience. Gastrointest Endosc, 54 (2001), 714–19.CrossRefGoogle Scholar
Giovannini, M., Seitz, J. F., Monges, G., et al. Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy, 27 (1995), 171–7.CrossRefGoogle ScholarPubMed
Williams, D., Sahai, A. V., Aabakken, L., et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut, 44 (1999), 720–6.CrossRefGoogle ScholarPubMed
Romagnuolo, J., Scott, J., Hawes, R. H., et al. Helical CT versus EUS with fine needle aspiration for coeliac nodal assessment in patients with esophageal cancer. Gastrointest Endosc, 55 (2002), 648–54.CrossRefGoogle Scholar
McGrath, K., Brody, D., Luketich, J., et al. Detection of unsuspected left hepatic lobe metastases during EUS staging of cancer of the esophagus and cardia. Am J Gastroenterol, 101 (2006), 1742–6.CrossRefGoogle ScholarPubMed
Prasad, P., Schmulewitz, N., Patel, A., et al. Detection of occult liver metastases during EUS for staging of malignancies. Gastrointest Endosc, 59 (2004), 49–53.CrossRefGoogle ScholarPubMed
Nguyen, P., Feng, J. C., Chang, K. J.. Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (FNA) of liver lesions. Gastrointest Endosc, 50 (1999), 357–61.CrossRefGoogle ScholarPubMed
Cerfolio, R., Bryant, A. S., Ohja, B., et al. The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg, 129 (2005), 1232–41.CrossRefGoogle Scholar
Kalha, I., Kaw, M., Fukami, N., et al. The accuracy of endoscopic ultrasound for restaging esophageal carcinoma after chemoradiation therapy. Cancer, 101 (2004), 940–7.CrossRefGoogle ScholarPubMed
Zuccaro, G., Rice, T. W., Goldblum, J., et al. Endoscopic ultrasound cannot determine suitability for esophagectomy after aggressive chemoradiotherapy for esophageal cancer. Am J Gastroenterol, 94 (1999), 906–12.CrossRefGoogle ScholarPubMed
Beseth, B., Bedford, R., Isacoff, W. H., et al. Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoadjuvant chemoradiotherapy. Am Surg, 66 (2000), 827–31.Google Scholar
Bowrey, D., Clark, G. W., Roberts, S. A., et al. Serial endoscopic ultrasound in the assessment of response to chemoradiotherapy for carcinoma of the esophagus. J Gastrointest Surg, 3 (1999), 462–7.CrossRefGoogle ScholarPubMed
Hirata, N., Kawamoto, K., Ueyama, T., et al. Using endosonography to assess the effects of neoadjuvant therapy in patients with advanced esophageal cancer. AJR Am J Roentgenol, 169 (1997), 485–91. Erratum in: AJR Am J Roentgenol 170 (1998), 510.CrossRefGoogle ScholarPubMed
Isenberg, G., Chak, A., Canto, M. I., et al. Endoscopic ultrasound in restaging of esophageal cancer after neoadjuvant chemoradiation. Gastrointest Endosc, 48 (1998), 158–63.CrossRefGoogle ScholarPubMed
Willis, J., Cooper, G. S., Isenberg, G., et al. Correlation of EUS measurement with pathologic assessment of neoadjuvant therapy response in esophageal carcinoma. Gastrointest Endosc, 55 (2002), 655–61.CrossRefGoogle ScholarPubMed
Chak, A., Canto, M. I., Cooper, G. S., et al. Endosonographic assessment of multimodality therapy predicts survival of esophageal carcinoma patients. Cancer, 88 (2000), 1788–95.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Westerterp, M., Westreenen, H. L., Reitsma, J. B., et al. Esophageal cancer: CT, endoscopic US and FDG-PET for assessment of response to neoadjuvant therapy: systematic review. Radiology, 23 (2005), 841–51.CrossRefGoogle Scholar
Harewood, G. and Kumar, K. S.. Assessment of clinical impact of endoscopic ultrasound on esophageal cancer. J Gastroenterol Hepatol, 19 (2004), 433–9.CrossRefGoogle ScholarPubMed
Preston, S., Clark, G. W., Martin, I. G., et al. Effect of endoscopic ultrasonography on the management of 100 consecutive patients with oesophageal and junctional carcinoma. Br J Surg, 90 (2003), 1220–4.CrossRefGoogle ScholarPubMed
Ainsworth, A., Mortensen, M. B., Durup, J., et al. Clinical impact of endoscopic ultrasonography at a country hospital. Endoscopy, 34 (2002), 447–50.CrossRefGoogle Scholar
Nickl, M., Bhutani, M. S., Catalano, M., et al. Clinical implications of endoscopic ultrasound: the American Endosonography Club Study. Gastrointest Endosc, 44 (1996), 371–7.CrossRefGoogle ScholarPubMed
Harewood, G. C. and Wiersema, M. J.. A cost analysis of endoscopic ultrasound in the evaluation of esophageal cancer. Am J Gastroenterol, 97 (2002), 452–8.CrossRefGoogle ScholarPubMed
Wallace, M., Netter, P. J., Earle, C., et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg, 74 (2002), 1026–32.CrossRefGoogle ScholarPubMed
Dam, J., Rice, T. W., Catalano, M. F., et al. High grade malignant stricture is predictive of tumor stage. Risks of endosonographic evaluation. Cancer, 71 (1993), 2910–17.Google ScholarPubMed
Mallery, S. and Dam, J.. Increased rate of complete EUS staging of patients with esophageal cancer using the nonoptical, wire-guided echoendoscope. Gastrointest Endosc, 50 (1999), 53–7.CrossRefGoogle ScholarPubMed
Pfau, P., Ginsberg, G. G., Lew, R. J., et al. Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective. Am J Gastroenterol, 95 (2000), 2813–15.CrossRefGoogle ScholarPubMed
Catalano, M., Dam, J., Sivak, M. V. Jr., et al. Malignant esophageal strictures: staging accuracy of endoscopic ultrasonography. Gastrointest Endosc, 41 (1995), 535–9.CrossRefGoogle ScholarPubMed
Wallace, M., Hawes, R. H., Sahai, A. V., et al. Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc, 51 (2000), 309–13.CrossRefGoogle ScholarPubMed
Kallimanis, G., Gupta, P. K., Al-Kawas, F. H., et al. Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe. Gastrointest Endosc, 41 (1995), 540–6.CrossRefGoogle ScholarPubMed
Binmoeller, K., Seifert, H., Seitz, U., et al. Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma. Gastrointest Endosc, 41 (1995), 547–52.CrossRefGoogle ScholarPubMed
Dhir, V., Mohandas, K. M., Mehta, S., et al. Endoscopic ultrasound staging of stenotic esophageal cancer: miniprobe, dilation, MH908 or helical computed tomography (CT)?Gastrointest Endosc, 56 (2002), S108.Google Scholar
Vu, C., Doig, L. A., Anderson, S., et al. Large series Western European experience with the Olympus MH908 slim-probe shows greater complete staging of esophageal cancer without the need for dilatation (abstract). Gastrointest Endosc, 59 (2004), AB213.CrossRefGoogle Scholar
Catalano, M., Sivak, M. V. Jr., Bedford, R. A., et al. Observer variation and reproducibility for endoscopic ultrasonography. Gastrointest Endosc, 41 (1995), 115–20.CrossRefGoogle ScholarPubMed
Palazzo, L. and Burtin, P.. Interobserver variation in tumor staging. Gastrointest Endosc Clin N Am, 5 (1995), 559–67.Google ScholarPubMed
Fockens, P., Brande, J. H., Dullemen, H. M., et al. Endosonographic T-staging of esophageal carcinoma: a learning curve. Gastrointest Endosc, 44 (1996), 58–62.CrossRefGoogle ScholarPubMed
Schlick, T., Heintz, A., and Junginger, T.. The examiner's learning effect and its influence on the quality of endoscopic ultrasonography in carcinomas of the esophagus and gastric cardia. Surg Endosc, 13 (1999), 894–8.CrossRefGoogle ScholarPubMed
Vliet, E. P. M., Eijkemans, M. J. C., Poley, J.-W., et al. Staging of esophageal carcinoma in a low-volume EUS center compared with reported results from high-volume centers. Gastrointest Endosc, 63 (2006), 938–47.CrossRefGoogle Scholar
Pellise, M., Castells, A., Gines, A., et al. Detection of lymph node micrometastases by gene promoter hypermethylation in samples obtained by endosonography-guided fine-needle aspiration biopsy. Clin Cancer Res, 10 (2004), 4444–9.CrossRefGoogle ScholarPubMed
Chang, K., Nguyen, P. T., Thompson, J. A., et al. Phase 1 clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine needle-injection in patients with advanced pancreatic carcinoma. Cancer, 88 (2000), 1325–35.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Hecht, J., Bedford, R., Abbruzzese, J. L., et al. A phase I/II trial of intramural endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res, 9 (2003), 555–61.Google Scholar
Goldberg, S., Mallery, S., Gazelle, G. S., et al. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc, 50 (1999), 392–401.CrossRefGoogle Scholar
Sun, S. and Wang, M.. Use of endoscopic ultrasound-guided injection in endoscopic resection of submucosal tumors. Endoscopy, 34 (2002), 82–5.CrossRefGoogle ScholarPubMed
Fritscher-Ravens, A., Appleyard, N., and Swain, P.. Real time echoendoscopic control of submucosal resection and polypectomy (abstract). Gastrointest Endosc, 55 (2002), AB254.Google Scholar
Fritscher-Ravens, A., Moss, A., Mukherjee, D., et al. Real time (miniprobe) EUS controlled endoscopic submucosal resection (abstract). Gastrointest Endosc, 53 (2001), AB128.Google Scholar

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