Endoscopic Assessment vs EUS in Superficial GI Neoplasia Staging

Key Takeaways:

• Investigators reported higher overall accuracy for high-definition endoscopic assessment than for EUS in distinguishing intramucosal (HGD/T1a) lesions from deeper invasion when compared with final histology.
• EUS was described as prone to overstaging for early T-depth assessment, while in the lymphadenectomy subgroup, the authors reported a high positive predictive value for N0 nodal status.
• Minimally invasive resection (EMR/ESD/TEM) was reported as frequently curative in this cohort, with a subset requiring rescue therapy and a small number requiring surgery for perforation.

The study included 57 patients/lesions evaluated at one center. Lesions were limited to the esophagus (19), stomach (29), and rectum (9), and final post-resection histology served as the reference standard. High-definition endoscopic assessment incorporated white-light evaluation with acetic acid enhancement and dye-based or virtual chromoendoscopy, and lesions were labeled “fit” or “unfit” for attempted en bloc endoscopic resection. After endoscopic assessment, 42/57 lesions were classified as fit for endoscopic resection, and these pre-resection calls were compared with post-resection histologic staging.

For identifying lesions limited to the mucosa (HGD or T1a) rather than deeper invasion, the authors reported high sensitivity (96.6%) and a high negative predictive value (93.3%) for endoscopic assessment in this cohort. They also described comparatively modest specificity alongside these rule-out characteristics, indicating that endoscopic labeling of “unfit” lesions less often missed intramucosal disease than did alternative categorizations.

For EUS, the authors described limited ability to refine early T-stage depth in this setting and noted a tendency toward overstaging, reporting 19 overstaged lesions versus 7 understaged lesions when compared with final pathology. For nodal assessment, they reported pathologic nodal confirmation in a subgroup of 25 patients who underwent lymphadenectomy; in that subgroup, the reported PPV of an EUS impression of N0 for pathologic N0 was 91.7% (with specificity and NPV reported as 0%).

Among 39 patients treated with minimally invasive approaches (EMR, ESD, or TEM), the authors reported technically successful and histologically curative resections in 28/39 (71.8%). They also reported that 11/39 (28.2%) required additional rescue treatment after non-curative resection or complications, and that 2/39 (5.1%) underwent surgery for perforation during ESD. These treatment outcomes were presented alongside the staging comparisons as part of the authors’ described pathway linking pre-resection assessment to definitive histology and subsequent management steps within this series.