The Accuracy Of Preoperative TN Staging Diagnosis Of Esophageal Cancer By Endoscopy And Its Influencing Factors

Objective To investigate the accuracy and influencing factors of endoscopic ultrasonography（EUS）in preoperative TN staging of esophageal cancer.Methods The information of 89 cases of esophageal cancer from October 2016 to September 2017 were retrospectively analyzed,including the patient’s age,sex,tumor length,tumor location,differentiation,general classification,number of lymph node dissection stations,pathological type,etc.We compared with the result of preoperative EUS examination stage and postoperative pathological stage,and explored the related factors affecting the accuracy of EUS stage.The staging of pathology is based on the American Joint Committee Cancer（AJCC）esophageal cancer 8th Edition TNM staging system standard.All patients were confirmed by electron gastroscopy and biopsy before admission.Results All compared with esophageal cancer postoperative pathologic staging,preoperative EUS examination T₁ staging accuracy was 82.02%（73/89）,T₂ staging accuracy was 77.53%（69/89）,T₃ staging accuracy was 84.27%（75/89）,T₄ stage accuracy was 91.01%（81/89）,the overall accuracy of T staging was 67.42%（60/89）.N₀ staging accuracy was 66.29%（59/89）,N₁ staging accuracy was 69.66%（62/89）,the overall accuracy of N staging was 60.67%（54/89）.Using the?2 test analyzes the factors affecting the accuracy of EUS in the staging of esophageal cancer TN.In the T stage of esophageal cancer,EUS is prone to excessive staging,which is affected by the general classification（P<0.01）.There were 22 cases of excessive staging in the T staging.The low stage in the T staging is relatively rare.EUS is prone to low stage of esophageal cancer in the N staging,which is related to the degree of tumor differentiation,general and classification（P<0.01,P<0.05）.There were 31 cases of low staging in the N staging.EUS is very rare in the overdiagnosis of N stage,of which only 4 cases have N stage overdiagnosis.Conclusion EUS has good diagnostic accuracy for preoperative T staging of esophageal cancer,with higher diagnostic value at T₁,T₃,and T₄,and slightly lower T₂ diagnostic value.EUS has good diagnostic value for the overall N staging of esophageal cancer,but the EUS specificity or sensitivity is not good enough.The diagnostic accuracy in N staging is influenced by many factors.EUS is a poor diagnostic value for distant metastases in tumors.Therefore,combined chest and abdomen enhanced CT and cervical lymph node ultrasound will make preoperative clinical staging of esophageal cancer patients more accurate.Selective EUS-FNA can help lymph node positive diagnosis of esophageal cancer and PET/CT can help improve diagnosis of distant metastases or relapsed patients.The accurate preoperative TNM staging of patients with esophageal cancer will be of great guiding significance for the choice of treatment measures.