Limitations of EUS in esophageal cancer staging
The accuracy of T staging by EUS varies with the actual stage of the tumor, with the least accurate being T1 tumors.
Strictures occur in approximately 30% of esophageal masses. Accuracy for staging is higher for traversable tumors compared with tumors occluding the lumen. Older literature suggested high perforation rates approaching 25% following dilation to allow passage of an echoendoscope, with recent studies suggesting the safety of pre-EUS dilation. Alternatively, a high-frequency ultrasound probe may be carefully advanced through a stricture.
EUS following chemoradiation is inaccurate with a tendency to overstage. Accuracy of EUS for T and N staging ranges from 50% to 60%.