EUS staging of upper GI malignancies: results of a prospective randomized trial

Gastrointest Endosc. 2006 Oct;64(4):496-502. doi: 10.1016/j.gie.2006.01.023. Epub 2006 Aug 22.

Abstract

Background: Electronic 270 degrees transverse-array EUS (TA-EUS) provides high-quality cross-sectional images but cannot guide FNA. Linear EUS (L-EUS) provides longitudinal images of malignancies and the ability to guide FNA.

Objective: We conducted a prospective randomized comparison of TA-EUS and L-EUS for the staging of upper-GI (UGI) malignancies.

Design: Forty-three patients underwent L-EUS immediately followed by TA-EUS (N = 27, 63%) or TA-EUS immediately followed by L-EUS (N = 16, 37%).

Patients: Forty-three subjects (mean age, 64 years; 37 men) with an UGI malignancy (4 stomach and 38 esophageal) were evaluated with both TA-EUS and L-EUS.

Interventions: Abnormal lymph nodes were sampled by FNA for cytology.

Results: There was agreement on the T stage by linear and radial techniques in 38 of 43 subjects (88%). Twenty-seven of 43 patients (63%) had abnormal lymph nodes by linear or transverse-array imaging. L-EUS demonstrated 66 abnormal lymph nodes in 27 subjects (average of 2.4 nodes/subject). TA-EUS demonstrated 90 abnormal lymph nodes in 27 subjects (average of 3.3 nodes/subject, P = .009, compared with L-EUS). In 16 of the 27 subjects, an FNA was performed, which was positive in 13 cases (81%) and negative in 3 cases (10%) for malignancy.

Conclusions: TA-EUS and L-EUS provide similar results of T staging of UGI malignancies. However, the number of abnormal lymph nodes detected by TA-EUS was more than by L-EUS. These findings suggest that radial or transverse-array EUS imaging should be the primary method for staging of UGI malignancies.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biopsy, Fine-Needle / instrumentation
  • Endosonography / instrumentation*
  • Equipment Design
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / pathology*
  • Esophagus / diagnostic imaging
  • Esophagus / pathology
  • Female
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Lymphatic Metastasis / pathology
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prospective Studies
  • Sensitivity and Specificity
  • Stomach / diagnostic imaging
  • Stomach / pathology
  • Stomach Neoplasms / diagnostic imaging*
  • Stomach Neoplasms / pathology*
  • Transducers*