ECA causes an estimated 12,000 cases of invasive GI cancers yearly. The prognosis of ECA is poor and survival is directly influenced by tumor penetration of the esophageal wall and lymph note metastasis. Treatment options are based on disease stage and those with distant metastasis are not considered for surgical resection. The revised TNM staging system establishes malignant celiac lymph node involvement as distant metastasis for tumors arising in the thoracic esophagus. EUS has been shown to be the most accurate diagnostic modality for establishing depth of tumor invasion and regional lymph node involvement. The accuracy of EUS in the evaluation of celiac axis (distant) lymph node metastasis is not well described. Methods: 210 pts with esophageal carcinoma were evaluated preoperatively with EUS, Of these, 145 underwent attempted surgical resection and staging. Pts were staged using the TNM classification. Local (mediastinal) and distant (celiac axis) lymph nodes were assessed for malignancy using four criteria (size greater than 1cm, round shape, homogeneous echo pattern, sharp borders). All pts underwent attempted surgical resection. Accuracy of EUS was determined by histopathology of the resected lymph nodes. Results: Surgical exploration revealed 19 of 145 pts with metastatic celiac axis lymph nodes and 93 mediastinal (local) affected lymph nodes in pts presenting with esophageal carcinoma. Using the above criteria for malignant lymph nodes, there were 15 true positive and 4 false negative results for celiac nodes. All pts with malignant celiac axis lymph nodes had local T3 (tumor breaching adventitia) or T4 (tumor invading adjacent organs) disease. MALIGNANT NODES Pts (No.) ENDOSCOPIC ULTRASOUND (EUS) TP TN FP FN SEN SPEC PPV NPV Celiac L.N. 19 of 145 15 124 2 4 79% 98% 88% 96% Local L.N. 93 of 145 74 32 20 19 80% 61% 79% 63% Conclusion: EUS is an excellent modality in the evaluation of metastatic celiac axis lymph nodes in pts with esophageal carcinoma and should be used to direct therapeutic options. Sensitivity is consistent with prior publications for local regional lymph nodes whereas specificity is significantly higher.
|Original language||English (US)|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging