Title : Accuracy of endoscopic ultrasound for tumour and nodal staging in gastro-oesophageal cancer: A single-centre study comparing endoscopic ultrasound with histopathology
Abstract:
Background: Accurate locoregional staging is essential in gastro-oesophageal cancer to guide treatment selection. Endoscopic ultrasound provides high-resolution assessment of tumour depth and regional lymph nodes, but real-world performance varies.
Aim: To evaluate the diagnostic performance of endoscopic ultrasound for tumour and nodal staging at clinically relevant decision thresholds by comparison with histopathology.
Methods: We conducted a retrospective single-centre study at the Royal Liverpool University Hospital (January 2021–December 2025). A total of 265 patients with gastro-oesophageal cancer were reviewed. Pre-treatment endoscopic ultrasound was performed in 55/265 (20.8%); three cases were excluded due to unavailable reports (external procedures). Of 52 patients with an endoscopic ultrasound report, 21 were excluded due to unavailable histopathology (5 unfit for surgery, 3 metastatic disease, 13 best supportive care). The final comparative cohort included 31 patients with paired endoscopic ultrasound staging and histopathology. Diagnostic performance was assessed for early disease (Tis/T1 vs ≥T2), advanced local disease (≥T3 vs ≤T2), and nodal status (N+ vs N0) using sensitivity, specificity and accuracy. Tis was grouped with T1 for threshold analyses.
Conclusions: In a paired histopathology cohort (n=31), endoscopic ultrasound showed high specificity but limited sensitivity for early (Tis/T1) disease, moderate discrimination for ≥T3 disease, and poor performance for nodal staging. These findings support using endoscopic ultrasound primarily to inform T-stage decision thresholds within MDT pathways, while nodal status should be interpreted cautiously and integrated with cross-sectional imaging; selective nodal sampling may be considered when results would change management.
Keywords: gastro-oesophageal cancer; endoscopic ultrasound; staging; diagnostic accuracy; histopathology; lymph nodes.
