Accuracy of EUS in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma

doi:10.1067/mge.2001.119216

Gastrointestinal Endoscopy

Volume 54, Issue 6, December 2001, Pages 689-696

Presented in part at the 12th International EUS Congress, February 11-13, 2000, Monte Carlo, Monaco.

https://doi.org/10.1067/mge.2001.119216 Get rights and content

Abstract

Background: Nonoperative therapy with intent to cure may be considered for patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma. However, a more advanced stage of disease must be precluded before such treatment. The potential of EUS for this purpose was evaluated. Methods: EUS was performed in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma based on endoscopy, endoscopic biopsies, and CT before esophagectomy. EUS findings were compared with surgical/pathologic evaluation. Results: EUS suggested submucosal invasion in 6 patients and lymph node involvement in 5 patients. By surgical/pathologic evaluation, 5 of 22 patients (23%) had unsuspected submucosal invasion and 1 had lymph node involvement. EUS detected all 5 instances of submucosal invasion and the single instance of lymph node involvement. EUS was falsely positive for submucosal invasion in 1 patient and for lymph node involvement in 4 patients. Sensitivity, specificity, and negative predictive values of preoperative EUS for submucosal invasion were 100%, 94%, and 100%, and for lymph node involvement were 100%, 81%, and 100%, respectively. A nodule or stricture noted by endoscopy was associated with an increased likelihood of submucosal invasion. Conclusions: In patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma, EUS detected otherwise unsuspected submucosal invasion and lymph node involvement. Patients should be evaluated with EUS when nonoperative therapy is contemplated. (Gastrointest Endosc 2001;54:689-96.)

Section snippets

Patients and methods

An EUS database was established in 1993. For all patients undergoing EUS, the US findings, including tumor stage, as well as results from adjunctive imaging studies, operative findings, and histopathology entered were recorded in this database. The Institutional Review Board of our hospital approved the procurement of these data for research purposes. A search of the EUS database with “Barrett's” as the keyword identified 32 patients with Barrett's esophagus and HGD or ImCa, based on endoscopy,

Results

EGD, EUS, and surgical pathologic findings are shown in Table 1 and detailed in Appendix 1.

. Endoscopic biopsy, EUS, and surgical pathologic findings displayed by presence or absence of a macroscopically recognizable lesion within Barrett's segment

Empty Cell	Empty Cell	BM + nodule and/or stricture (%)	BM only (%)	p Value
Number of patients		12 (55)	10 (45)
Histopathology on forceps biopsy	HGD	8 (75)	7 (70)	0.99
	ImCA	4 (25)	3 (30)
Disruption of submucosal layer by EUS	−	7 (58)	9 (90)	0.16
	+	5 (42)	1 (10)
EUS T-stage	T cis/1a	7 (58)	9 (90)	0.16^*

Discussion

The rising incidence of adenocarcinoma of the esophagus and the dismal prognosis for patients when adenocarcinoma is diagnosed at an advanced stage has reinforced efforts to detect cancerous transformation in its earliest stages. Enhanced surveillance is expected to increase the number of persons with a diagnosis of superficial lesions such as HGD or ImCa. Among patients who have undergone esophagectomy for HGD, coexistent invasive adenocarcinoma is identified in 30% to 47% when the resection

Disclosure

Drs. Ginsberg and Kochman have served as paid consultants for, have received research assistance in the form of equipment donation from, and have received invited speaker honoraria from Olympus America, Inc.

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^☆: Reprint requests: Gregory G Ginsberg, MD, Division of Gastroenterology, 3 Ravdin, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.

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Original ArticlesAccuracy of EUS in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Disclosure

Gastroenterology

Gastro Clin N Amer

Gastroenterology

Gastroenterology

Gastroenterol Clin North Amer

Gastroenterol Clin North Amer

Gastroenterol Clin North Amer

Amer J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Am J Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Gastroenterology

Gastrointest Endosc

Original Articles
Accuracy of EUS in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma☆