Staging of esophageal carcinoma: endoscopic ultrasonography

Endoscopic ultrasonography (EUS) has gained ground in the staging of esophageal cancer because of its high accuracy in determining depth of tumor invasion (greater than 80%) and lymph node metastases. The accuracy of EUS increases with increasing stage. However within T1 tumors, EUS performance in distinguishing mucosal (T1m) form submucosal invasion (T1sm) is poor. In this context high-frequency ultrasonography probes can play a major role. The advent of EUS-guided fine-needle aspiration (EUS-FNA) has dramatically changed the impact of EUS on nodal staging, providing cytological confirmation of malignancy from peritumoral and celiac lymph nodes. Especially celiac node metastases, have a major clinical impact on patient management. Widespread use of EUS in the staging of esophageal cancer should be encouraged. However, EUS should not be considered as first line test for evaluation of these patients and should always be performed after negative CT or PET/CT.