Evaluating the Additional Value of Endoscopic Ultrasonography for Depth Assessment of Esophagogastric Junction Adenocarcinoma

Objectives

Endoscopic ultrasonography (EUS) is sometimes used to assess the depth of invasion in esophagogastric junction adenocarcinoma (EGJA); however, its diagnostic performance in EGJA remains unclear. This study aimed to evaluate the additional value of EUS to conventional endoscopy (CE) in assessing invasion depth.

Methods

In this single-institution retrospective study, we compared the diagnostic performance of CE alone with that of CE + EUS for preoperative depth assessment of early-stage EGJA. In addition, we examined the clinicopathologic features associated with incorrect depth assessment.

Results

The study included 93 cases of early-stage EGJA. Comparing the diagnostic performance for diagnosing submucosal cancer (CE vs. CE + EUS), CE + EUS had a significantly lower specificity than CE alone (78.4% vs. 62.2%). However, no significant differences were observed in sensitivity (73.2% vs. 71.4%) and accuracy (75.3% vs. 67.7%) between the two modalities. The addition of EUS was associated with significantly higher misdiagnosis rates in the following types of lesions: lesions located on the esophageal side (42.6% vs. 25.5%), elevated lesions (29.2% vs. 15.4%), complex lesions (32.7% vs. 16.3%), and lesions with hiatal hernia (31.1% vs. 19.7%). No clinicopathological factors were significantly associated with overdiagnosis or underdiagnosis.

Conclusions

The addition of EUS to CE reduced the ability to accurately identify mucosal cancers in early-stage EGJA, suggesting a risk of overdiagnosis and unnecessary therapeutic escalation.