D. Giugliano1, F. Palazzo1, M. Pucci1, E. Rosato1, C. Lamb1, D. Levine1, A. Berger1 1Thomas Jefferson University,Philadelphia, PA, USA
Introduction: Endoscopic ultrasound (EUS) has been shown to be the most accurate method for staging patients with esophageal cancer. After neoadjuvant chemoradiation therapy (CRT), CT and PET scan are often used over EUS for re-staging due to post-treatment fibrosis and inflammation that may make EUS staging inaccurate. The aim of this study was to compare EUS staging and pathologic staging in patients who underwent induction therapy prior to esophagectomy.
Methods: We queried our IRB-approved prospective foregut database to identify a total of 26 patients from 2001 to 2015 who underwent post-induction EUS re-staging for locally advanced esophageal cancer. EUS post-induction stage was compared to pathologic stage. EUS nodal status was determined by nodal morphology and size and not by biopsy.
Results: The majority of patients (n=24, 92.3%) were diagnosed with adenocarcinoma. The average age was 58 years old (range: 41-77 years). Most patients (n=22 patients, 84.6%) were male. EUS over-staged tumors for the majority of patients (n=12, 46.2%). It correctly staged 26.9% (n=7) of patients and understaged 26.9% (n=7) of patients. Tumor size (T) was most often overestimated (n=13, 50.0%), as compared to being correctly estimated in 26.9% (n=7) of patients and underestimated in 23.1% (n=6) of patients. Finally, nodal status (N) was most often correct (n=15, 57.7%), and was underestimated in 26.9% (n=7) of patients and overestimated in 15.4% (n=4) of patients.
Conclusion: Post-neoadjuvant chemoradiation therapy re-staging using EUS most often overstages esophageal tumors. Tumor size is most often overestimated, while nodal status is most often correct. Subsequent therapy should not rely on post-neoadjuvant EUS stage.