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. 2005 Mar;100(3):601-6.
doi: 10.1111/j.1572-0241.2005.41167.x.

Endoscopic ultrasound errors in esophageal cancer

Gregory Zuccaro Jr  1 , Thomas W Rice, John J Vargo, John R Goldblum, Lisa A Rybicki, John A Dumot, David J Adelstein, Patricia A Trolli, Eugene H Blackstone
Affiliations

Endoscopic ultrasound errors in esophageal cancer

Gregory Zuccaro Jr et al. Am J Gastroenterol. 2005 Mar.

Erratum in

  • Am J Gastroenterol. 2005 May;100(5):1216. Zuccaro, Gregory [added]; Rybicki, Lisa [added]

Abstract

Background: Previous assessments of endoscopic ultrasound (EUS) classification of esophageal cancer are dominated by symptomatic patients with advanced stage disease. Fewer data exist on EUS errors in a cohort balanced between early and advanced disease.

Purpose: Assess EUS errors in classification of esophageal cancer in a more balanced cohort, and identify clinical and tumor characteristics associated with EUS errors.

Methods: A total of 266 patients underwent EUS and esophagectomy without preoperative chemoradiotherapy. Pathologic classification of disease extent: 108 (41%) tumors were confined to the esophageal wall (pTis-pT2, pN0, pM0); 158 (59%) were advanced beyond (pT3-pT4, pN1, or pM1). Logistic regression analysis was performed to identify correlates of error in T classification and disease extent using 10 clinical and tumor characteristics (gender, age, dysphagia, weight loss, tumor length, location, traversability, morphology, histopathologic type, and histologic grade).

Results: EUS erroneously predicted pathologic T (pT) in 119 patients (45%). When T classification was dichotomized into tumors whose depth of invasion was not beyond the muscularis propria (pTis-pT2) and those beyond (pT3-pT4), errors occurred in 42 patients (16%). EUS erroneously predicted N classification in 67 patients (25%), and was insensitive to the presence of distant metastases. EUS misclassified disease extent in 40 patients (15%). Logistic regression analysis indicated that weight loss and tumor length were the only clinical and tumor characteristics correlated with EUS errors; more weight loss was associated with decreased odds of misclassification, while the odds of misclassification were four to six times greater for intermediate length tumors than for shorter tumors.

Conclusions: EUS errors, particularly in predicting pT, are more frequent than previously reported. Weight loss and tumor length are the only clinical and tumor characteristics correlated with EUS errors.

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