Introduction EUS+/-FNA has been regarded as a standard investigation for T and N staging of oesophageal and oesophagogastric junctional (OGJ) cancer. The increased availablility of PET-CT has led to many centres reducing their use of EUS and relying more on non-invasive assessment of lymph node involvement. The aim of this study was to retrospectively analyse the outcomes from EUS following the introduction of PET-CT into a single regional unit.
Methods The computerised records of all patients diagnosed with oesophageal or OGJ cancer and discussed at a regional MDM between March 2009 and February 2011 were analysed. Patients felt to be suitable for radical treatment based upon initial endoscopy, CT scan and review of referral letter underwent a combination of PET-CT +/- EUS. The final staging pathway and management of this group of patients were analysed retrospectively.
Results 593 patients were diagnosed and presented to the regional MDM. 412 (69%) were directed towards palliative treatment following initial assessment. Of the remaining 181 (31%), PET-CT was undertaken in 180 and EUS in 99 (55%). FNA was undertaken in 31 (31%) of those undergoing EUS. One patient (1%) had a perforation related to dilatation prior to planned EUS. A covered stent was inserted and he was discharged from hospital. The findings on PET-CT directly changed management to a palliative approach in 30 patients (17%). A further 75 patients (42%) required further investigations based upon PET-CT including EUS (n=52), colonoscopy (n=9), review by other specialities (n=6), lymph node excision biopsy (n=2), radiological guided FNA/core biopsy (n=3) and MRI liver (n=2). EUS was performed to investigate nodal status in 51 (52%), to confirm the presence or depth of tumour invasion in 21 (21%) and to investigate other organ involvement in 3 (3%). 24 EUS procedures were performed routinely due to protocols used at that time. EUS+/-FNA directed patients to a palliative approach in 22 (22%). Management was directed to a radical approach in 72 (73%), and to endoscopic treatment (EMR/PDT) in 5 (5%). In the 98 patients who had both PET-CT and EUS, there was concordance of lymph node status in 79 (85%). Ten (11%) patients with negative nodes on PET-CT had positive nodes on EUS (of which 5 were suspicious at the time of staging CT), and 4 (4%) with positive nodes on PET-CT had negative nodes on EUS. Five had incomplete EUS due to stricturing.
Conclusion These results demonstrate that EUS has a complementary role in the staging process, with EUS playing an essential role in 11% of patients where confirmation of lymph node status, not identified on PET-CT, guided appropriate management.
Competing interests None declared.