[MOL] Effective imaging study for determining the T and N stages of esop [00884] Medicine On Line


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[MOL] Effective imaging study for determining the T and N stages of esophageal carcinoma?



What is the most effective imaging study for determining the T and N stages of esophageal carcinoma?


Endoscopic ultrasonography (EUS) is the single best modality for staging esophageal cancer with respect to depth of tumor infiltration and extent of lymph node involvement using the TNM classification system. The accuracy of EUS for staging patients with esophageal carcinoma who subsequently underwent surgery for confirmation ranged from 59% to 92% (with a mean of 84% in 1154 patients); the accuracy for N staging ranged from 50% to 90% (with a mean of 77% in 1035 patients). Endosonography is superior to CT in the T and N staging of disease.

However, EUS is not a sensitive tool for diagnosing tumor involvement of the trachea and bronchial tree, because these structures contain air. Bronchoscopy should be used for the staging of proximal esophageal cancers. If esophageal cancers obstruct the lumen and the EUS endoscope cannot be advanced through, tumor staging is incomplete.

EUS employs the technology of endoscopy and internally placed high-frequency ultrasound waves to visualize the gastrointestinal wall and adjacent structures. EUS is fast emerging as an important modality for the diagnosis and staging of benign and malignant lesions of the gut wall and the surrounding structures of the mediastinum, abdomen, and pelvis. Interventional applications, such as EUS-guided fine needle aspiration (EUS-FNA) for obtaining tissue/fluid samples, for pseudocyst drainage, and also for delivery of local therapy will likely enhance the clinical utility and cost-effectiveness of this imaging modality.

The widest application of EUS is, however, in the diagnosis and staging of esophageal, gastric, rectal, and pancreaticobiliary carcinoma. While endosonography is the most accurate study available for determining the T and N stages of these neoplasms, EUS-FNA can cytologically confirm the diagnosis and staging of disease with tissue. EUS has been shown to change the approach to clinical management in a significant portion of patients to a less costly, risky, or invasive strategy.

Warmly, lillian
 
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