A prospective comparative study of optical coherence tomography and EUS for tumor staging of superficial esophageal squamous cell carcinoma

Background: The precise assessment of superficial esophageal squamous cell carcinomas (SESCCs) limited to the epithelium (EP) or lamina propria mucosa (LPM), the standard indication for endoscopic resection, is important to ensure good outcomes of endoscopic resection. With regard to tomographic imaging techniques, although the accuracy of EUS is practically insufficient, we previously demonstrated that high-resolution optical coherence tomography (OCT) might enable precise assessment for staging in a noninvasive and real-time manner. Objective: To clarify the accuracy of the preoperative staging of SESCCs by using OCT compared with that by using 20-MHz probe-type EUS. Design: A prospective study. Setting: An academic medical center. Patients: A total of 123 consecutive patients with 131 SESCCs were enrolled from May 2007 to September 2011. Interventions: A specialist examined the patients, by using both OCT and EUS, recorded a representative still image for each lesion, and reported the staging immediately after each examination. Another blinded investigator reviewed the recorded images and reported the staging independently. The histological staging was confirmed by the resected specimens. Finally, we calculated the accuracy of staging by using OCT and EUS. Main Outcome Measurements: The accuracy of OCT or EUS for EP/LPM. Result: The accuracy for EP/LPM by using OCT was significantly higher than that by using EUS (OCT, 94.6%; HF-EUS, 80.6%; P < .05). Interobserver agreement of OCT and EUS was good and moderate, respectively. Limitations: The small number of patients; a single-center, single-operator, nonrandomized, crossover study. Conclusions: We prospectively demonstrated that the preoperative staging of SESCC by using OCT was more useful than that by using EUS. (Gastrointest Endosc 2012;76:548-55.)