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Oesophageal I
PTU-180 What is the role of EUS in nodal staging of oesophageal cancer in the era of PET-CT?
  1. G J Bryce1,
  2. M J Forshaw1,
  3. A J Stanley2,
  4. N Jamieson2,
  5. S Paterson3,
  6. S Ballantyne4
  1. 1Department of UGI Surgery, Glasgow Royal Infirmary, Glasgow, UK
  2. 2Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  3. 3Department of Gastroenterology, Stirling Royal Infirmary, Stirling, UK
  4. 4Department of Radiology, Gartnavel General Hospital, Glasgow, UK

Abstract

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.

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