Impact of EUS-FNA in the Management of Patients with Oesophageal Cancer

Background: Endoscopic ultrasound (EUS) increases the accuracy of T and N stages directing the patient to more appropriate therapy. EUS-FNA provides cytological evidence of malignancy and is superior to CT and standard EUS in assessing malignant nodes.

Aim: To assess the impact of EUS-FNA in the management of patients with oesophageal cancer (OC).

Methods: Patients with OC considered for radical therapy underwent EUS between May '03 and Aug '05. Suspicious nodes distant to the tumour were sampled by EUS-FNA (≥3 passes with a 22-guage needle). All patients underwent CT and further staging as appropriate. Individual results were discussed and therapy decisions were made at our multidisciplinary meeting (MDM).

Results: 140 patients underwent EUS for OC; 36 EUS-FNAs were performed in 34 patients (26 male). Mean (SD) age was 61.9 (9.2) years. Twenty patients (59%) had adenocarcinoma and 14 (41%) squamous carcinoma. Eleven required oesophageal dilation for the examination. Seventeen nodes were <1cm diameter. Nodes sampled were in the mediastinum/subcarinal area in 14, coeliac axis in 10 and left gastric/other subdiaphragmatic area in 12. Twenty nodes (56%) were malignant and two were suspicious for malignancy. On the basis of EUS-FNA proven positive nodes and after discussions at the MDM, 14 patients were recommended palliative therapy instead of radical therapy with surgery or chemo/radiotherapy; one patient underwent neo-adjuvant therapy. Eight patients with negative nodes on EUS-FNA had radical therapy instead of palliative therapy. Therefore the results of EUS-FNA altered management in 23 (68%) patients. EUS-FNA did not alter management in 11 patients who underwent palliative therapy due to either co-morbidity or the findings on CT or other imaging.

Conclusion: EUS-FNA is a valuable investigation for staging OC and allows patients to be directed towards appropriate therapy.