Takeaway
- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) leads to altered staging of upper gastrointestinal (GI) cancer, allowing more patients to be directed to the appropriate therapeutic pathways after multidisciplinary team discussion than would have been the case using positron emission tomography-computed tomography (PET-CT) staging alone.
Why this matters
- PET-CT is currently recommended for the assessment and staging of upper GI cancer, but its role in this setting remains controversial.
- This study suggests EUS-FNA has a critical role in determining malignancy in suspicious nodes identified on PET-CT.
Key results
- Of 108 patients, 62 had histological diagnosis of adenocarcinoma (30 oesophageal; 28 junctional; 4 gastric) and 46 had oesophageal squamous cell carcinoma (SCC).
- 37 were positive on both PET-CT and EUS-FNA and 34 were negative, giving overall concordance of 65.7%.
- Concordance rate was 71.7% with SCC vs 61.3% with adenocarcinoma.
- Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) results of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively.
- 34 (31.5%) patients had positive PET-CT findings but negative EUS-FNA cytology.
- 3 (2.8%) had negative PET-CT findings and positive EUS-FNA.
- 37 patients had discordant findings.
- EUS-FNA led directly to an alteration in clinical staging and management in 27 (25%) patients.
Study design
- Retrospective review of prospectively recorded data on all patients diagnosed with upper GI cancer between January 2009 and December 2015.
- Funding: none specified.
Limitations
- Some clinical information missing.
- Interpretation of mediastinal nodal involvement and designation of patients as either PET-CT positive or negative was a subjective judgement.
- Relatively short follow-up.
- Lack of surgical findings.
References
References
