The Value of Endoscopic Ultrasound and Computed Tomography in Lymph Node Staging of Early Barrett's Cancer

Endoscopic ultrasound (EUS) and computed tomography (CT) are part of the regular staging programme in esophageal cancer. We evaluated the value of both techniques in early Barrett's cancer (BC). Methods: 93 patients (mean age 63.7±10.7 years) with BC, who were refered to our hospital for endoscopic therapy were prospectively included in a standardised staging programme with upper endoscopy, EUS (7.5 MHz obligatory, 12.5 or 20 MHz facultative), abdominal ultrasound and computed tomography of the thorax. After staging, 83 patients were treated endoscopically, 10 received esophageal resection. Due to the lymph node (LN) findings in CT and/or EUS alle patients were categorised in 3 categories: C1: n=49 (no suspicious LN); C2: n=36 (paraesophageal LN on tumor level ≤ 1 cm; LN ≥ 1 cm (not tumor level, mediastinum or Tr. coeliacus) and C3: n=8 (paraesophageal LN on tumor level < 1 cm). These findings were controlled every 6 months by EUS and CT, 10 patients were refered to surgery. Results: The mean follow-up was 24.5±7.4 months. EUS detected enlarged LN of C2 in 30% (n=28) and of C3 in 8.6% (n=8). Malignant LN were detected in C1 n=2, C2 n=1 and C3 n=4. In C2 enlarged LN were found by CT alone in 8 patients, by EUS alone in 17 patients and by both methods in 11 patients. In C3 pathological LN were detected in 8 patiens by EUS alone and by both methods in 2 patients. That means, that CT missed 23/47 LN (53.3%) and EUS missed 8/47 LN (18.2%). Sensitivity of EUS was 0.76 and of CT 0.44. When looked at the subgroup of patient who received esophageal resection, of 7 patiens wit histologically proven malignant LN 4 were found by EUS and none by CT. Staging of local tumor stage by EUS: T1a n=47 (histologically correct (hc) n=35), T1b n=6 (hc n=2), T2 n=2 (hc n=1). Conclusion: According to the presented results CT seems to be insufficient in staging of early Barrett's cancer and should not be used for staging of early BC. EUS detects more enlarged LN, only few of them are malignant. Therefore, and because of the ability of EUS to assess the local tumor stage (T-category), EUS should routinely be used in the staging of patients with early BC. During follow-up EUS should be performed in patients with T1a-cancer and LN of C2 and 3 and when submucosal invasion was found.