ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (On-Demand) | February 2023-Mishra

Mishra_EUS Masterclass Cancer Staging

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This document provides a case-based presentation on the staging of various gastrointestinal (GI) cancers using endoscopic ultrasound (EUS). The presenter, Girish Mishra, highlights ten key points for effective EUS cancer staging, including the preference for radial imaging over linear imaging, the limited role of EUS in metastatic disease staging, the need for caution when interpreting tangential imaging, and the importance of carefully inspecting the vasculature for tumor involvement or thrombus formation. <br /><br />Mishra then discusses the staging of specific GI cancers. For esophageal cancer, EUS can accurately predict tumor stage and lymph node metastasis, guiding treatment decisions. EUS is particularly useful in identifying early-stage cancers suitable for endoscopic resection. In stomach cancer, EUS can assess tumor location, extent, and involvement of the gastroesophageal junction, providing valuable information for surgeons and oncologists. Preoperative therapy is recommended for T2 or higher stage disease. <br /><br />For ampullary lesions, EUS is superior to computed tomography (CT) for staging and can help identify lesions amenable to endoscopic ampullectomy. In pancreatic cancer, EUS plays a complementary role to cross-sectional imaging and is valuable for obtaining tissue samples for analysis. Genetic analysis is an emerging field in pancreatic cancer staging. <br /><br />In rectal cancer, EUS is used to identify patients who would benefit from neoadjuvant chemoradiation. It accurately stages tumor invasion into the rectal wall and involvement of regional lymph nodes. EUS can also assess the involvement of surrounding structures such as the internal anal sphincter, prostate, or seminal vesicles. EUS has good sensitivity and specificity for tumor staging, but magnetic resonance imaging (MRI) offers advantages in evaluating distant pelvic lymph nodes, peritoneal reflection, and distance from the mesorectal fascia. <br /><br />Overall, EUS is an invaluable tool for staging luminal GI cancers, allowing for accurate characterization of tumor stage, lymph node involvement, and evaluation of adjacent structures. It guides treatment decisions and helps optimize patient management.

Keywords

endoscopic ultrasound

EUS cancer staging

radial imaging

metastatic disease staging

esophageal cancer

stomach cancer

ampullary lesions

pancreatic cancer

rectal cancer

neoadjuvant chemoradiation