Pre-operative staging of gastro-oesophageal junction carcinoma: comparison of endoscopic ultrasound and computed tomography

Fifteen patients with carcinoma of the gastro-esophageal junction were pre-operatively staged with endoscopic ultrasound (EUS) and computed tomography (CT). The accuracy of tumour and nodal staging using both modalities was compared to the final histological staging of the resected specimens. In staging depth of tumour growth, EUS was significantly more accurate (87% of lesions correctly staged) than CT (40% correctly staged). In staging nodal involvement, EUS was again significantly more accurate (73% correctly staged) than CT (33%). Two thirds of the lesions were traversable with the endoscopic probe, but most of the nontraversed lesions were correctly staged on EUS. In this study, CT has performed poorly as a staging modality for carcinoma at the gastro-oesophageal junction. Other studies have shown CT to be less accurate at this location than at other oesophageal sites. The orientation of the gastro-oesophageal junction, lack of surrounding fat planes, proximity of adjacent organs and patient motion contribute to the poor staging performance of CT at this location. In contrast, EUS has been an accurate staging modality at the gastro-oesophageal junction in this study and compares well with other studies evaluating EUS in the more proximal oesophagus. Endoscopic ultrasound is therefore a necessary modality if accurate pre-operative staging of gastro-oesophageal junction carcinoma is to be achieved. 32 refs., 5 tabs., 5 figs