Experience of endoscopic ultrasound in staging adenocarcinoma of the cardia

doi:10.1053/ejso.1999.0713

European Journal of Surgical Oncology (EJSO)

Volume 25, Issue 6, December 1999, Pages 595-598

https://doi.org/10.1053/ejso.1999.0713 Get rights and content

Abstract

Aim: The introduction of endoscopic ultrasonography (EUS) has generally resulted in a more accurate assessment of gastrointestinal regional tumour stage. Knowing the stage and the extent of oesophageal involvement is extremely important as a guide to the choice of surgical approach in cardia cancer. The aim of this study was to evaluate the ability of EUS to accurately predict depth of tumour invasion (T), node involvement (N) and the tumour's invasion length along the oesophagus. Material and methods Thirty-five patients with adenocarcinoma of the cardia were studied by EUS and the EUS pre-operative findings were compared with the pathology findings. Results: The overall accuracy in T staging was 55.2% (16/29 cases). The sensitivity in evaluating T1, T2 and T3 classes was 80%, 38.5% and 70%, respectively. The sensitivity was excellent in evaluating N0 class (100%) (5 cases), but it fell to 66.7% in N1 cases. EUS correctly determined the extent of oesophagus invasion in 75.9% (22/29) of cases; moreover, it had a very high accuracy in distinguishing between tumours with an oesophageal invasion greater or lower than 2 cm (93.1%) (27/29 cases). Conclusion: EUS proved to be useful in pre-operative staging of cardia adenocarcinoma and, in particular, in the pre-operative identification of the extent of oesophageal invasion.

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Esophageal and gastric cancers are distinct carcinomas of the upper gastrointestinal tract, although the distinction between them becomes less clear at the gastroesophageal junction (GEJ). Increasingly accurate staging is possible based on newer radiographic and surgical techniques such as positron emission tomography (PET), laparoscopy and thoracoscopy, laparoscopic ultrasound, and endoscopic ultrasound (EUS). For both cancer types, tumor classification is determined by depth of penetration of the primary tumor into the gastric or esophageal wall. For esophageal cancer, primary tumor anatomic position-upper, mid, and lower esophagus-is used to define the local nodal basin. Metastases in nodes outside the local basin are considered to be distant (M) rather than regional (N). In gastric cancer, the region of nodal metastasis has been abandoned in favor of the number of lymph nodes containing metastasis, which predicts outcome more accurately—patients with more than 15 positive lymph nodes have an outcome comparable to those with M disease. Increasing consideration is being given to the subclassification of tumors near the GEJ into types based on anatomical position, although this staging scheme (“ $A$ denocarcinoma of the $E$ sophago $G$ astric junction” or AEG type) has not yet been universally adopted. We review the current pathologic staging systems for esophageal and gastric cancers, the clinical staging approaches for these diseases, and the controversy surrounding classification of tumors of the GEJ.
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The feasibility of a less invasive operation for early stage cancer of the gastric cardia with a low frequency of lymph node involvement has been previously demonstrated by us. Precise discrimination among mucosal, submucosal, and advanced cancers, as well as accurate evaluation of the proximal tumor margin are prerequisites for such stage-specific treatment. EUS is considered the most reliable staging modality. However, there is no EUS study specifically of cardia cancer.
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^f1: Correspondence to: Giovanni de Manzoni MD, 1st Division of General Surgery, Borgo Trento Hospital, Piazza Stefani 1, 37126 Verona–Italy; Fax: +39 45 8345355.

View full text

Experience of endoscopic ultrasound in staging adenocarcinoma of the cardia

Abstract

Hum Pathol

Gastroenterology

Gastrointest Endosc

Ann Thorac Surg

Changes in the location and type of gastric adenocarcinoma

Cancer

Adenocarcinoma of the lower esophagus and the esophagogastric junction

Semin Diagn Pathol

Changing patterns in gastric adenocarcinomas

Br J Surg

Kardiacarcinoma: versuch einer therapeutisch relevanten klassifikation

Chirurg

Endoscopic ultrasonography

Endoscopy

Role of endoscopic ultrasonography in esophageal carcinoma

Endoscopy

Role of endoscopic ultrasonography in gastric carcinoma

Endoscopy

Local staging and assessment of resectability in carcinoma of the esophagus, stomach and duodenum

Gastrointest Endosc