Abstract
Background and Study Aims: Esophageal invasion by carcinoma of the cardia may affect the surgical approach.
Accurate assessment of esophageal invasion is difficult using endoscopy, computed
tomography, or barium contrast radiography. The aim of the present study was to evaluate
the use of endoscopic ultrasonography (EUS) in the prediction of esophageal invasion
by carcinoma of the cardia.
Patients and Methods: EUS (using a linear-array scanner) was carried out prospectively in 47 patients with
carcinoma of the cardia who underwent subsequent surgical resection. The findings
were correlated with the histopathological assessment of tumor infiltration in the
esophagus in the resected specimen.
Results: An absence of esophageal invasion was correctly predicted by EUS in 12 of 13 patients.
Histopathologically confirmed invasion of the esophagus was correctly predicted in
32 of 34 patients. With a margin of error of 10 mm, the accuracy of EUS in predicting
or excluding histologically confirmed invasion of the esophagus was 85.1 % (40 of
47 patients). False-positive results with EUS occurred in patients with prominent
edematous or fibrous changes in the distal esophagus; false-negative results with
EUS were seen in patients with scattered infiltration of a small number of tumor cells
into the mucosal or submucosal layer.
Conclusion: EUS can provide the surgeon with additional information on the extent of esophageal
infiltration in patients with carcinoma of the gastric cardia, and can therefore assist
in the selection of the surgical approach.
