Surgically resected T1-and T2-stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

초록

This study aimed to evaluate the frequency of nodal metastases and to disclose the diagnostic performance of endoscopic ultrasonography (EUS) and PET/CT in T and N staging in surgically resected early-stage esophageal squamous cell carcinomas (eSCCs). Institutional review board approved this retrospective study with waiver of informed consent for reviewing medical record. We included 435 patients with an early T-stage (Tis or Tl a [<= T1a], T1b and T2) eSCC. The rates of metastatic lym-phadenopathy were calculated. Then, the performance of EUS and PET/CT in subdividing T and N stages was assessed. 131 <= T1 a, 234 T1b, and 70 T2 eSCCs were identified. In discriminating <= Tla from other cancers, the sensitivity, specificity, and accuracy of EUS were 60.3% (79/131), 80.3% (244/304), and 74.3% (323/435) re-spectively. With ROC curve analysis, cut-off value of SUVmax 3.05 at PET provided sensitivity 74.8% (98/131), specificity 70.1% (213/304), and accuracy 71.5% (311/435) for differentiating <= T1a eSCCs from others. Ten (7.6%) of 131 <= T1a cancers had nodal metastasis. In discriminating N0 from node-positive disease, sensitivity, specificity, and accuracy of EUS were 89.6% (267/298), 41.6% (57/137), and 74.5% (324/435), respectively, whereas those of PET/CT were 88.9% (265/298),38.7% (53/137), and 73.1% (318/435) respectively. In >70% of patients with <= T1a eSCCs, the tumor stage can be discriminated from higher stage cancers by using EUS or PET/CT. Substantial percentage (7.6%) of <= T1a eSCC patients have nodal metas-tases, which are missed in more than half of the patients in clinical staging.

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