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

Mishra_EUS Masterclass Cancer Staging

Pdf Summary

In this presentation on EUS cancer staging, Dr. Girish Mishra highlights key points and tips for effective staging of various gastrointestinal (GI) cancers using endoscopic ultrasound (EUS). Some of the key takeaways from the presentation are as follows:<br /><br />1. When performing luminal staging, radial EUS should be preferred over linear EUS to make the process easier.<br />2. EUS cancer staging is not necessary for metastatic disease unless a tissue sample is needed for diagnosis.<br />3. Tangential imaging should be avoided as it can falsely indicate T3 staging.<br />4. Multiple views may be necessary during rectal ultrasound (RUS) to accurately stage sphincter muscles that may blend with the surrounding tissue.<br />5. Mucosal staging should typically begin with a regular endoscope, as it can detect subtle lesions.<br />6. When staging UGI cancers, the liver, particularly the left lobe near the gastroesophageal (GE) junction, should always be assessed.<br />7. The celiac region should be evaluated even in cases of pancreatic cancer, hepatocellular carcinoma (HCC), and cholangiocarcinoma.<br />8. Cystic lesions in the mediastinum and rectum should not be subjected to fine needle aspiration (FNA) due to the risk of complications.<br />9. FNA in rectal lesions carries a higher risk of infection, even with antibiotic use.<br />10. Careful inspection of the vasculature can provide valuable information about tumor involvement or the presence of a tumor thrombus.<br /><br />The presentation also covers specific staging techniques and considerations for esophageal, stomach, ampullary, pancreatic, and rectal cancers. EUS has demonstrated good accuracy in staging these cancers, with pooled sensitivities ranging from 80% to 96% and specificities ranging from 90% to 99%. However, it is important to note that EUS alone may not be sufficient for restaging after treatment.<br /><br />The presentation concludes by emphasizing the importance of accurately staging luminal cancers to guide appropriate treatment decisions. The role of EUS is complementary to other imaging modalities, and it can provide valuable information for neoadjuvant therapies, determining residual or distant disease, and identifying lesions amenable to endoscopic resection. Overall, EUS plays a crucial role in optimizing the management of GI cancers.

Keywords

EUS cancer staging

endoscopic ultrasound

gastrointestinal cancers

radial EUS

linear EUS

metastatic disease

rectal ultrasound

mucosal staging

UGI cancers

fine needle aspiration