Value of high-frequency miniprobes and conventional radial endoscopic ultrasound in the staging of early Barrett's carcinoma

Background and aims: High-frequency miniprobes (HFPs) and conventional radial endoscopic ultrasonography (crEUS) are considered valuable tools in the staging of early Barrett's cancer. However, there is some controversy on whether HFPs are superior in the T staging of Barrett's cancer or whether the same level of accuracy can be achieved by the sole use of crEUS.

Patients and methods: Patients referred for endoscopic treatment for Barrett's cancer were included in this prospective crossover trial and were randomly assigned to either HFPs or crEUS as the initial diagnostic method. Afterwards, all of the patients were re-examined with the alternative procedure. The staging results obtained with each method were documented prospectively.

Results: A total of 43 patients (median age 66 years [interquartile range: 58 – 73]; 34-male) were included. A total of 23 mucosal and 16 submucosal Barrett's cancers were confirmed at histology. Histological confirmation was not possible in four patients. Assessment of the T category was not possible with HFPs in 7 % of patients, compared with 33 % with crEUS (P < 0.0001) due to positioning problems. T category was correctly assessed with HFP in 64 % of patients and with crEUS in 49 %.

Conclusions: HFPs are significantly superior to crEUS for local staging of Barrett's cancer. However, the accuracy of assessment of the T category was unsatisfactory with both techniques.

References

• 1 Pohl H, Welch H G. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.  J Natl Cancer Inst. 2005;  97 142-146
• 2 Reid B J, Levine D S, Longton G. et al . Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets.  Am J Gastroenterol. 2000;  95 1669-1676
• 3 Schnell T G, Sontag S J, Chejfec G. et al . Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia.  Gastroenterology. 2001;  120 1607-1609
• 4 Buttar N S, Wang K K, Sebo T J. et al . Extent of high-grade dysplasia in Barrett's esophagus correlates with risk of adenocarcinoma.  Gastroenterology. 2001;  120 1630-1639
• 5 Fountoulakis A, Zafirellis K D, Dolan K. et al . Effect of surveillance of Barrett's oesophagus on the clinical outcome of oesophageal cancer.  Br J Surg. 2004;  91 997-1003
• 6 Aldulaimi D M, Cox M, Nwokolo C U, Loft D E. Barrett's surveillance is worthwhile and detects curable cancers. A prospective cohort study addressing cancer incidence, treatment outcome and survival.  Eur J Gastroenterol Hepatol. 2005;  17 943-950
• 7 Prasad G A, Wang K K, Buttar N S. et al . Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus.  Gastroenterology. 2007;  132 1226-1233
• 8 Ell C, May A, Gossner L. et al . Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.  Gastroenterology. 2000;  118 670-677
• 9 Pech O, Behrens A, May A. et al . Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus.  Gut. 2008;  57 1200-1206
• 10 Pech O, May A, Rabenstein T, Ell C. Endoscopic resection of early oesophageal cancer.  Gut. 2007;  56 1625-1634
• 11 van Vliet E P, Heijenbrok-Kal M H, Hunink M G. et al . Staging investigations for oesophageal cancer: a meta-analysis.  Br J Cancer. 2008;  98 547-557
• 12 Puli S R, Reddy J B, Bechtold M L. et al . Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review.  World J Gastroenterol. 2008;  14 1479-1490
• 13 Pech O, May A, Günter E. et al . The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett's esophagus.  Am J Gastroenterol. 2006;  101 2223-2229
• 14 Japanese Gastric Cancer Association . Japanese Classification of Gastric carcinoma. 2nd English edn.  Gastric Cancer. 1998;  1 10-24
• 15 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.  Gastrointest Endosc. 2003;  58 (6 Suppl) S3-S43
• 16 Hamilton SR, Aaltonen LA eds Pathology and genetics of tumours of the digestive system. (World Health Organization classification of tumours). Lyons; International Agency for Research on Cancer (IARC) Press 2000
• 17 Pech O, Gossner L, Manner H. et al . Prospective evaluation of the macroscopic types and location of early Barrett's neoplasia in 380 lesions.  Endoscopy. 2007;  39 588-593
• 18 Peters F P, Brakenhoff K P, Curvers W L. et al . Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus.  Gastrointest Endosc. 2008;  67 604-609
• 19 Bhutani M S, Hawes R H, Hoffmann B J. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion.  Gastrointest Endosc. 1997;  45 474-479
• 20 May A, Guenter E, Roth F. et al . Accuracy of staging in oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial.  Gut. 2004;  53 634-640
• 21 Scotiniotis I A, Kochman M L, Lewis J D. et al . Accuracy of EUS in the evaluation of Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma.  Gastrointest Endosc. 2001;  54 89-696
• 22 Larghi A, Lightdale C J, Memeo L. et al . EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett's esophagus.  Gastrointest Endosc. 2005;  62 16-23
• 23 Chemaly M, Scalone O, Durivage G. et al . Miniprobe EUS in the pretherapeutic assessment of early esophageal neoplasia.  Endoscopy. 2008;  40 2-6
• 24 Esaki M, Matsumoto T, Moriyama T. et al . Probe EUS for the diagnosis of invasion depth in superficial esophageal cancer: a comparison between a jelly-filled method and a water-filled balloon method.  Gastrointest Endosc. 2006;  63 389-395
• 25 Rampado S, Bocus P, Battaglia G. et al . Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus.  Ann Thorac Surg. 2008;  85 251-256
• 26 Buskens C J, Westerterp M, Lagarde S M. et al . Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features.  Gastrointest Endosc. 2004;  60 703-710