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Comparative study between endoscopic ultrasonography and positron emission tomography-computed tomography in staging patients with esophageal squamous cell carcinoma


  • Specific author contributions: Conception and design: Hsiu-Po Wang; Analysis and interpretation of the data: Tsorng-Jou Yen and Chen-Shuan Chung; Drafting of the article: Tsorng-Jou Yen and Chen-Shuan Chung; Collection and assembly of the data: Tsorng-Jou Yen, Chen-Shuan Chung, Yen-Wen Wu, Ruoh-Fang Yen, Mei-Fang Cheng, Jang-Ming Lee, Chih-Hung Hsu, and Yih-Leong Chang; Critical revision of the article for important intellectual content: Tsorng-Jou Yen, Chen-Shuan Chung, and Hsiu-Po Wang; Final approval of the article: Hsiu-Po Wang.

  • Competing interests: All authors declare that they do not have any conflicts of interest related to this work.

  • License for publication: ‘The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd. and its Licensees to permit this article (if accepted) to be published in Diseases of the Esophagus editions and any other BMJPGL products to exploit all subsidiary rights, as set out in our license (’

Dr Hsiu-Po Wang, MD, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, No. 7, Chung-Shan S. Road, Taipei 100, Taiwan. Email:


Treatment strategy of esophageal cancer mainly depends on accurate staging. At present, no single ideal staging modality is superior to another in preoperative tumor-node-metastasis (TNM) staging of patients with esophageal cancer. We aimed to investigate the efficacy of endoscopic ultrasonography (EUS) and positron emission tomography-computed tomography (PET-CT) for staging of esophageal cancer. We retrospectively studied 118 consecutive patients with esophageal squamous cell carcinoma who underwent esophagectomy with or without neoadjuvant chemoradiotherapy (CRT) over a near 3-year period between January 2005 and November 2008 at a tertiary hospital in Taiwan. Patients were separated into two groups: without neoadjuvant CRT (group 1, n= 28) and with CRT (group 2, n= 90). Medical records of demographic data and reports of EUS and PET-CT of patients before surgery were reviewed. A database of clinical staging by EUS and PET-CT was compared with one of pathological staging. The accuracies of T staging by EUS in groups 1 and 2 were 85.2% and 34.9%. The accuracies of N staging by EUS in groups 1 and 2 were 55.6% and 39.8%. The accuracies of T and N staging by means of PET-CT scan were 100% and 54.5% in group 1, and were 69.4% and 86.1% in group 2, respectively. In group 2, 38 of 90 patients (42.2%) achieved pathologic complete remission. Among them, two of 34 (5.9%) and 12 of 17 (70.6%) patients were identified as tumor-free by post-CRT EUS and PET-CT, respectively. EUS is useful for initial staging of esophageal cancer. PET-CT is a more reliable modality for monitoring treatment response and restaging. Furthermore, the accuracy of PET-CT with regard to N staging is higher in patients who have undergone CRT than those who have not.