Value of endoscopic ultrasound staging in conjunction with the evaluation of lymphovascular invasion in identifying low-risk esophageal carcinoma

BACKGROUND. With increasing emphasis on endoscopic therapy (ET) for T1 esophageal carcinoma, the identification of low-risk patients is critical. It was hypothesized that endoscopic ultrasonography (EUS) in concert with detailed histopathologic evaluation would identify low-risk cancers for an appropriate but organ-preserving strategy. METHODS. All patients who had pretreatment EUS and underwent esophagectomy as primary therapy for esophageal cancer between 1999 and 2006 were analyzed retrospectively. The accuracy of EUS in predicting the correct pathologic stage was assessed along with a histopathologic reevaluation including lymphovascular invasion (LVI). Pathologic stage and various features were incorporated into a multivariate logistic regression model. RESULTS. A total of consecutive 87 esophageal cancer patients (81 with adenocarcinoma) were evaluable for this analysis. EUS correctly diagnosed 59 T1 cancers and 20 T2-4 cancers but understaged cancers in 2 patients and overstaged cancers in 6 patients. EUS correctly identified 8 patients with lymph node metastases but not 13 other patients. The accuracy, sensitivity, and specificity of EUS for T1 cancers were 91%, 91%, and 91%, respectively; for T1a (intramucosal) cancers, the accuracy, sensitivity, and specificity were: 82%, 67%, and 93%, respectively, and for lymph node involvement these same values were 81%, 38%, and 94%, respectively. LVI was found to be an independent predictor of lymph node metastases on the multivariate analysis (P = .02). CONCLUSIONS. Data from the current study demonstrate that EUS has excellent accuracy, sensitivity, and specificity (91% each) for identifying T1 esophageal cancers and LVI is an independent predictor of lymph node metastases. A strategy for preservation of the esophagus may be possible in patients who have EUS-designated T1 cancer without LVI after successful ET.