Staging Accuracy and Lymph Node Involvement in Superficial Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus — a Multicenter Case Series Analysis
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Staging Accuracy and Lymph Node Involvement in Superficial Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus — a Multicenter Case Series Analysis. / Egeland, Charlotte; Grundahl, Anne Sofie; Hübner, Cecilie; Kjaer, Daniel; Dikinis, Sarunas; Grossjohann, Hanne; Achiam, Michael Patrick.
I: Indian Journal of Surgery, Bind 86, Nr. 1, 2024, s. 98-105.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Staging Accuracy and Lymph Node Involvement in Superficial Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus — a Multicenter Case Series Analysis
AU - Egeland, Charlotte
AU - Grundahl, Anne Sofie
AU - Hübner, Cecilie
AU - Kjaer, Daniel
AU - Dikinis, Sarunas
AU - Grossjohann, Hanne
AU - Achiam, Michael Patrick
N1 - Publisher Copyright: © 2023, The Author(s).
PY - 2024
Y1 - 2024
N2 - At an early stage, esophageal cancer can be removed surgically or endoscopically. T1a tumors are removed by endoscopic resection, whereas T1b tumors are preferably surgically removed (esophagectomy) due to possible lymph node involvement. However, the diagnostic tools (endoscopic ultrasonography (EUS) and CT/PET-CT) used to distinguish between T1a and T1b tumors and to detect malignant lymph nodes are imprecise. This study aimed to review the accuracy of preoperative locoregional staging in superficial esophageal cancer in a Danish setting. This was a retrospective, multicenter study including patients with a cT1 esophageal tumor, both adenocarcinoma and squamous cell carcinoma. Patients receiving neoadjuvant treatment were excluded. Results from the preoperative diagnostics tools were compared with the pathology report to determine the diagnostic accuracy. Sixty-eight patients were included, 34 patients underwent esophagectomy, and 34 patients underwent endoscopic resection. The positive predictive value (PPV) of PET-CT (or CT) (when staged as a T1 tumor) was 77% (95%CI: 0.59–0.88), and the PPV of EUS (when staged as a T1a or T1b tumor) was 52% (95%CI: 0.32–0.72) and 60% (95%CI: 0.36–0.82), respectively. Six patients had malignant lymph nodes in the surgical specimen; none of them was identified before surgery. In conclusion, neither CT/PET-CT nor EUS is a precise tool to distinguish mucosal from submucosal esophageal tumors. Furthermore, in superficial malignant lesions, lymph node involvement is rare, but when present, it is rarely detected before surgery. To improve staging accuracy, all patients with cT1 tumors could be referred for a diagnostic endoscopic resection prior to possible other treatments.
AB - At an early stage, esophageal cancer can be removed surgically or endoscopically. T1a tumors are removed by endoscopic resection, whereas T1b tumors are preferably surgically removed (esophagectomy) due to possible lymph node involvement. However, the diagnostic tools (endoscopic ultrasonography (EUS) and CT/PET-CT) used to distinguish between T1a and T1b tumors and to detect malignant lymph nodes are imprecise. This study aimed to review the accuracy of preoperative locoregional staging in superficial esophageal cancer in a Danish setting. This was a retrospective, multicenter study including patients with a cT1 esophageal tumor, both adenocarcinoma and squamous cell carcinoma. Patients receiving neoadjuvant treatment were excluded. Results from the preoperative diagnostics tools were compared with the pathology report to determine the diagnostic accuracy. Sixty-eight patients were included, 34 patients underwent esophagectomy, and 34 patients underwent endoscopic resection. The positive predictive value (PPV) of PET-CT (or CT) (when staged as a T1 tumor) was 77% (95%CI: 0.59–0.88), and the PPV of EUS (when staged as a T1a or T1b tumor) was 52% (95%CI: 0.32–0.72) and 60% (95%CI: 0.36–0.82), respectively. Six patients had malignant lymph nodes in the surgical specimen; none of them was identified before surgery. In conclusion, neither CT/PET-CT nor EUS is a precise tool to distinguish mucosal from submucosal esophageal tumors. Furthermore, in superficial malignant lesions, lymph node involvement is rare, but when present, it is rarely detected before surgery. To improve staging accuracy, all patients with cT1 tumors could be referred for a diagnostic endoscopic resection prior to possible other treatments.
KW - Diagnostic tools
KW - Endoscopic resection
KW - Endoscopic ultrasonography
KW - Esophageal cancer
KW - Locoregional staging
KW - Lymph node metastases
U2 - 10.1007/s12262-023-03789-x
DO - 10.1007/s12262-023-03789-x
M3 - Journal article
AN - SCOPUS:85159082371
VL - 86
SP - 98
EP - 105
JO - Indian Journal of Surgery
JF - Indian Journal of Surgery
SN - 0972-2068
IS - 1
ER -
ID: 367351515