N-staging of oesophageal and junctional carcinoma: Is there still a role for EUS in patients staged N0 at PET/CT?

•PET/CT is being increasingly utilised for staging oesophageal cancer.•PET/CT has been shown to have similar diagnostic accuracy to EUS for local staging.•In patients staged N0 on PET/CT, EUS N-stage is an independent predictor of survival.•EUS N+ patients have poorer survival than EUS N0, in those staged PET/CT N0.•EUS and PET/CT should continue to be used in a multi-modality approach to staging OC.

AimTo assess whether separate endoscopic ultrasound (EUS) lymph node (N)-staging is still of prognostic value in those staged node negative (N0) at combined positron-emission tomography/computed tomography (PET/CT) in patients with oesophageal cancer (OC).Materials and methodsOne hundred and seventeen consecutive patients [median age 67 years; 88 male; 98 cases of adenocarcinoma, 19 cases of squamous cell carcinoma (SCC)] staged as N0 at PET/CT underwent EUS to record tumour (T)- and N-stage. The patients were subsequently separated into two groups: EUS N0 (n = 78) and EUS N+ (n = 39). Survival analysis using Kaplan–Meier and Cox's proportional hazard methods was performed. Primary outcome was overall survival from diagnosis.ResultsEUS N-stage and EUS N0 versus EUS N+ (p = 0.005 and p = 0.001, respectively) were found to be significantly and independently associated with survival in two models of multivariate analysis, in patients staged N0 at PET/CT. EUS T-stage was significantly associated with survival on univariate analysis.ConclusionEUS N-staging still has prognostic value in patients staged N0 at PET/CT. There is a significant difference in survival between EUS N0 and positive nodal EUS status in those staged N0 at PET/CT, suggesting PET/CT is unreliable for local staging. PET/CT and EUS continue to have complimentary roles in OC staging.