Endosonographic staging of upper intestinal malignancy

Area of Science:

• Gastroenterology
• Oncology
• Diagnostic Imaging

Background:

• Endoscopic ultrasonography (EUS) has demonstrated high diagnostic accuracy in staging esophageal and gastric carcinoma over 25 years.
• Recent meta-analyses confirm EUS's significant role and allow comparison with alternative staging methods.
• The evolving landscape of cancer management and staging algorithms necessitates a re-evaluation of EUS's position.

Purpose of the Study:

• To review the established role and diagnostic accuracy of EUS in esophageal and gastric carcinoma staging.
• To assess the challenges and limitations of EUS in current and future cancer management strategies.
• To explore the potential of EUS-guided interventions and advanced imaging in refining cancer staging.

Main Methods:

• Comprehensive literature review of studies on EUS for esophageal and gastric carcinoma staging.
• Analysis of meta-analyses comparing EUS with other imaging modalities.
• Evaluation of recent advancements in cross-sectional imaging and EUS-guided techniques.

Main Results:

• EUS exhibits high accuracy in loco-regional staging of esophageal and gastric cancer.
• The role of EUS is limited in restaging after neoadjuvant therapy and assessing early-stage cancers for endoscopic treatment.
• Cross-sectional imaging advancements pose a challenge to EUS's preeminence in staging.
• EUS-guided fine-needle aspiration provides cytological confirmation of lymph node metastases.

Conclusions:

• EUS remains a valuable tool for staging esophageal and gastric carcinoma, despite evolving clinical practices.
• New challenges arise from neoadjuvant treatments, early cancer assessment, and competing imaging technologies.
• EUS-guided fine-needle aspiration offers unique advantages for lymph node staging and potential molecular staging.