Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 6/2013

01-06-2013 | Original Article

Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy—Results of a Multicenter Cohort Analysis

Authors: Hauke Sebastian Heinzow, Hans Seifert, Sven Tsepetonidis, Heiner Wolters, Torsten Kucharzik, Wolfram Domschke, Dirk Domagk, Tobias Meister

Published in: Journal of Gastrointestinal Surgery | Issue 6/2013

Login to get access

Abstract

Background

Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC).

Methods

Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen's kappa statistics.

Results

For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: –/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen's kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients.

Conclusion

EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.
Literature
1.
go back to reference Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12): 2893–917.PubMedCrossRef Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12): 2893917.PubMedCrossRef
2.
go back to reference Cook MB, Chow WH, Devesa SS. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Br J Cancer 2009; 101(5): 855–9.PubMedCrossRef Cook MB, Chow WH, Devesa SS. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Br J Cancer 2009; 101(5): 8559.PubMedCrossRef
3.
go back to reference Bosetti C, Levi F, Ferlay J, Garavello W, Lucchini F, Bertuccio P, Negri E, La Vecchia C. Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer 2008; 122(5): 1118–29.PubMedCrossRef Bosetti C, Levi F, Ferlay J, Garavello W, Lucchini F, Bertuccio P, Negri E, La Vecchia C. Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer 2008; 122(5): 111829.PubMedCrossRef
4.
go back to reference Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997; 337(3): 161–7.PubMedCrossRef Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997; 337(3): 1617.PubMedCrossRef
5.
go back to reference Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347(21): 1662–9.PubMedCrossRef Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347(21): 16629.PubMedCrossRef
6.
go back to reference Sykes AJ, Burt PA, Slevin NJ, Stout R, Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol 1998; 48(1): 15–21.PubMedCrossRef Sykes AJ, Burt PA, Slevin NJ, Stout R, Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol 1998; 48(1): 1521.PubMedCrossRef
7.
go back to reference Tougeron D, Di Fiore F, Thureau S, Berbera N, Iwanicki-Caron I, Hamidou H, Paillot B, Michel P. Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer. Br J Cancer 2008; 99(10): 1586–92.PubMedCrossRef Tougeron D, Di Fiore F, Thureau S, Berbera N, Iwanicki-Caron I, Hamidou H, Paillot B, Michel P. Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer. Br J Cancer 2008; 99(10): 158692.PubMedCrossRef
8.
go back to reference Abrams JA, Buono DL, Strauss J, McBride RB, Hershman DL, Neugut AI. Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly. Cancer 2009; 115(21): 4924–33.PubMedCrossRef Abrams JA, Buono DL, Strauss J, McBride RB, Hershman DL, Neugut AI. Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly. Cancer 2009; 115(21): 492433.PubMedCrossRef
9.
go back to reference Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19(2): 305–13.PubMed Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19(2): 30513.PubMed
10.
go back to reference Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, Gebski V. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 2011; 12(7): 681–92.PubMedCrossRef Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, Gebski V. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 2011; 12(7): 68192.PubMedCrossRef
11.
go back to reference Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 2007; 8(3): 226–34.PubMedCrossRef Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 2007; 8(3): 22634.PubMedCrossRef
12.
go back to reference Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut 2010; 60(11): 1449–72.CrossRef Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut 2010; 60(11): 144972.CrossRef
13.
go back to reference Dittler HJ, Bollschweiler E, Siewert JR. [What is the value of endosonography in the preoperative staging of esophageal carcinoma?]. Dtsch Med Wochenschr 1991; 116(15): 561–6.PubMedCrossRef Dittler HJ, Bollschweiler E, Siewert JR. [What is the value of endosonography in the preoperative staging of esophageal carcinoma?]. Dtsch Med Wochenschr 1991; 116(15): 5616.PubMedCrossRef
14.
go back to reference Lowe VJ, Booya F, Fletcher JG, Nathan M, Jensen E, Mullan B, Rohren E, Wiersema MJ, Vazquez-Sequeiros E, Murray JA, Allen MS, Levy MJ, Clain JE. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2005; 7(6): 422–30.PubMedCrossRef Lowe VJ, Booya F, Fletcher JG, Nathan M, Jensen E, Mullan B, Rohren E, Wiersema MJ, Vazquez-Sequeiros E, Murray JA, Allen MS, Levy MJ, Clain JE. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2005; 7(6): 42230.PubMedCrossRef
15.
go back to reference Rosch T. Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin N Am 1995; 5(3): 537–47.PubMed Rosch T. Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin N Am 1995; 5(3): 53747.PubMed
16.
go back to reference Takashima S, Takeuchi N, Shiozaki H, Kobayashi K, Morimoto S, Ikezoe J, Tomiyama N, Harada K, Shogen K, Kozuka T. Carcinoma of the esophagus: CT vs MR imaging in determining resectability. AJR Am J Roentgenol 1991; 156(2): 297–302.PubMedCrossRef Takashima S, Takeuchi N, Shiozaki H, Kobayashi K, Morimoto S, Ikezoe J, Tomiyama N, Harada K, Shogen K, Kozuka T. Carcinoma of the esophagus: CT vs MR imaging in determining resectability. AJR Am J Roentgenol 1991; 156(2): 297302.PubMedCrossRef
17.
go back to reference Vilgrain V, Mompoint D, Palazzo L, Menu Y, Gayet B, Ollier P, Nahum H, Fekete F. Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR Am J Roentgenol 1990; 155(2): 277–81.PubMedCrossRef Vilgrain V, Mompoint D, Palazzo L, Menu Y, Gayet B, Ollier P, Nahum H, Fekete F. Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR Am J Roentgenol 1990; 155(2): 27781.PubMedCrossRef
18.
go back to reference Misra S, Choi M, Livingstone AS, Franceschi D. The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer. Surg Endosc 2012; 26(2): 518–22.PubMedCrossRef Misra S, Choi M, Livingstone AS, Franceschi D. The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer. Surg Endosc 2012; 26(2): 51822.PubMedCrossRef
19.
go back to reference Faigel DO, Baron TH, Lewis B, Petersen B, Petrini J. Ensuring competence in endoscopy. Prepared by the ASGE taskforce on ensuring competence in endoscopy and American College of Gastroenterology executive and practice management committees. ASGE policy and procedures manual for gastrointestinal endoscopy: guidelines for training and practice on CD-ROM. ASGE 2005: 1–36. Faigel DO, Baron TH, Lewis B, Petersen B, Petrini J. Ensuring competence in endoscopy. Prepared by the ASGE taskforce on ensuring competence in endoscopy and American College of Gastroenterology executive and practice management committees. ASGE policy and procedures manual for gastrointestinal endoscopy: guidelines for training and practice on CD-ROM. ASGE 2005: 136.
20.
go back to reference Greene F, Page D, Fleming I, Fritz A, Balch C, Haller D, Morrow M, AJCC cancer staging manual. 6th ed. 2002, New York: Springer. Greene F, Page D, Fleming I, Fritz A, Balch C, Haller D, Morrow M, AJCC cancer staging manual. 6th ed. 2002, New York: Springer.
21.
go back to reference Stahl M, Budach W, Meyer HJ, Cervantes A. Esophageal cancer: clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5: v46-9.PubMedCrossRef Stahl M, Budach W, Meyer HJ, Cervantes A. Esophageal cancer: clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5: v46-9.PubMedCrossRef
22.
go back to reference Fedeli U, Schievano E, Lisiero M. Mortality after esophageal and gastric cancer resection. World J Surg 2012; 36(11): 2630–6.PubMedCrossRef Fedeli U, Schievano E, Lisiero M. Mortality after esophageal and gastric cancer resection. World J Surg 2012; 36(11): 26306.PubMedCrossRef
23.
go back to reference Ferguson MK, Martin TR, Reeder LB, Olak J. Mortality after esophagectomy: risk factor analysis. World J Surg 1997; 21(6): 599–603; discussion 603–4.PubMedCrossRef Ferguson MK, Martin TR, Reeder LB, Olak J. Mortality after esophagectomy: risk factor analysis. World J Surg 1997; 21(6): 599603; discussion 6034.PubMedCrossRef
24.
go back to reference Miller JD, Jain MK, de Gara CJ, Morgan D, Urschel JD. Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 1997; 65(1): 20–1.PubMedCrossRef Miller JD, Jain MK, de Gara CJ, Morgan D, Urschel JD. Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 1997; 65(1): 201.PubMedCrossRef
25.
go back to reference Marks JL, Hofstetter W, Correa AM, Mehran RJ, Rice D, Roth J, Walsh G, Vaporciyan A, Erasmus J, Chang J, Maru D, Lee JH, Lee J, Ajani JA, Swisher SG. Salvage esophagectomy after failed definitive chemoradiation for esophageal adenocarcinoma. Ann Thorac Surg 2012; 94(4): 1126–32; discussion 1132–3. PubMedCrossRef Marks JL, Hofstetter W, Correa AM, Mehran RJ, Rice D, Roth J, Walsh G, Vaporciyan A, Erasmus J, Chang J, Maru D, Lee JH, Lee J, Ajani JA, Swisher SG. Salvage esophagectomy after failed definitive chemoradiation for esophageal adenocarcinoma. Ann Thorac Surg 2012; 94(4): 112632; discussion 11323. PubMedCrossRef
26.
go back to reference Griffin JM, Reed CE, Denlinger CE. Utility of restaging endoscopic ultrasound after neoadjuvant therapy for esophageal cancer. Ann Thorac Surg 2012; 93(6): 1855–9; discussion 1860. Griffin JM, Reed CE, Denlinger CE. Utility of restaging endoscopic ultrasound after neoadjuvant therapy for esophageal cancer. Ann Thorac Surg 2012; 93(6): 18559; discussion 1860.
27.
go back to reference Sunpaweravong S, Ruangsin S, Laohawiriyakamol S, Mahattanobon S, Geater A. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg 2012; 35(3): 104–9.PubMedCrossRef Sunpaweravong S, Ruangsin S, Laohawiriyakamol S, Mahattanobon S, Geater A. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg 2012; 35(3): 1049.PubMedCrossRef
28.
go back to reference Meister T, Heinzow HS, Osterkamp R, Wehrmann T, Kucharzik T, Domschke W, Domagk D, Seifert H. Miniprobe endoscopic ultrasound accurately stages esophageal cancer and guides therapeutic decisions in the era of neoadjuvant therapy: results of a multicenter cohort analysis. Surg Endosc 2013. Meister T, Heinzow HS, Osterkamp R, Wehrmann T, Kucharzik T, Domschke W, Domagk D, Seifert H. Miniprobe endoscopic ultrasound accurately stages esophageal cancer and guides therapeutic decisions in the era of neoadjuvant therapy: results of a multicenter cohort analysis. Surg Endosc 2013.
29.
go back to reference Preston SR, Clark GW, Martin IG, Ling HM, Harris KM. Effect of endoscopic ultrasonography on the management of 100 consecutive patients with oesophageal and junctional carcinoma. Br J Surg 2003; 90(10): 1220–4.PubMedCrossRef Preston SR, Clark GW, Martin IG, Ling HM, Harris KM. Effect of endoscopic ultrasonography on the management of 100 consecutive patients with oesophageal and junctional carcinoma. Br J Surg 2003; 90(10): 12204.PubMedCrossRef
30.
go back to reference Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 2001; 49(4): 534–9.PubMedCrossRef Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 2001; 49(4): 5349.PubMedCrossRef
31.
go back to reference Kutup A, Vashist YK, Groth S, Vettorazzi E, Yekebas EF, Soehendra N, Izbicki JR. Endoscopic ultrasound staging in gastric cancer: does it help management decisions in the era of neoadjuvant treatment? Endoscopy 2012; 44(6): 572–6.PubMedCrossRef Kutup A, Vashist YK, Groth S, Vettorazzi E, Yekebas EF, Soehendra N, Izbicki JR. Endoscopic ultrasound staging in gastric cancer: does it help management decisions in the era of neoadjuvant treatment? Endoscopy 2012; 44(6): 5726.PubMedCrossRef
32.
go back to reference Koch J, Halvorsen RA, Jr. Staging of esophageal cancer: computed tomography, magnetic resonance imaging, and endoscopic ultrasound. Semin Roentgenol 1994; 29(4): 364–72.PubMedCrossRef Koch J, Halvorsen RA, Jr. Staging of esophageal cancer: computed tomography, magnetic resonance imaging, and endoscopic ultrasound. Semin Roentgenol 1994; 29(4): 36472.PubMedCrossRef
33.
go back to reference Laterza E, de Manzoni G, Guglielmi A, Rodella L, Tedesco P, Cordiano C. Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy. Ann Thorac Surg 1999; 67(5): 1466–9.PubMedCrossRef Laterza E, de Manzoni G, Guglielmi A, Rodella L, Tedesco P, Cordiano C. Endoscopic ultrasonography in the staging of esophageal carcinoma after preoperative radiotherapy and chemotherapy. Ann Thorac Surg 1999; 67(5): 14669.PubMedCrossRef
34.
go back to reference Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Bohle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Hocht S, Hofheinz RD, Hofler H, Hohler T, Holscher AH, Horneber M, Hubner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Korber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Monig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Rocken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schutte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline “Diagnosis and treatment of esophagogastric cancer”]. Z Gastroenterol 2011; 49(4): 461–531. PubMedCrossRef Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Bohle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Hocht S, Hofheinz RD, Hofler H, Hohler T, Holscher AH, Horneber M, Hubner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Korber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Monig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Rocken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schutte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline “Diagnosis and treatment of esophagogastric cancer”]. Z Gastroenterol 2011; 49(4): 461531. PubMedCrossRef
35.
go back to reference Mennigen R, Tuebergen D, Koehler G, Sauerland C, Senninger N, Bruewer M. Endoscopic ultrasound with conventional probe and miniprobe in preoperative staging of esophageal cancer. J Gastrointest Surg 2008; 12(2): 256–62.PubMedCrossRef Mennigen R, Tuebergen D, Koehler G, Sauerland C, Senninger N, Bruewer M. Endoscopic ultrasound with conventional probe and miniprobe in preoperative staging of esophageal cancer. J Gastrointest Surg 2008; 12(2): 25662.PubMedCrossRef
36.
go back to reference Pech O, Gunter E, Dusemund F, Origer J, Lorenz D, Ell C. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 2010; 42(6): 456–61.PubMedCrossRef Pech O, Gunter E, Dusemund F, Origer J, Lorenz D, Ell C. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 2010; 42(6): 45661.PubMedCrossRef
37.
go back to reference Kelly S, Berry E, Roderick P, Harris KM, Cullingworth J, Gathercole L, Hutton J, Smith MA. The identification of bias in studies of the diagnostic performance of imaging modalities. Br J Radiol 1997; 70(838): 1028–35.PubMed Kelly S, Berry E, Roderick P, Harris KM, Cullingworth J, Gathercole L, Hutton J, Smith MA. The identification of bias in studies of the diagnostic performance of imaging modalities. Br J Radiol 1997; 70(838): 102835.PubMed
Metadata
Title
Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy—Results of a Multicenter Cohort Analysis
Authors
Hauke Sebastian Heinzow
Hans Seifert
Sven Tsepetonidis
Heiner Wolters
Torsten Kucharzik
Wolfram Domschke
Dirk Domagk
Tobias Meister
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 6/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2189-2

Other articles of this Issue 6/2013

Journal of Gastrointestinal Surgery 6/2013 Go to the issue