Elsevier

Gastrointestinal Endoscopy

Volume 40, Issue 4, July–August 1994, Pages 442-446
Gastrointestinal Endoscopy

Endosonographic features predictive of lymph node metastasis,☆☆,,★★,,♢♢

Presented in part at the 1993 Annual meeting of the American Society of Gastrointestinal Endoscopy, Boston, MA
https://doi.org/10.1016/S0016-5107(94)70206-3Get rights and content

Abstract

Endosonographic features that are thought to characterize lymph node metastasis were evaluated in 100 patients with esophageal carcinoma. Subjects underwent preoperative endoscopic ultrasonography to assess depth of tumor invasion (T stage) and lymph node metastasis (N stage). Endosonographically imaged lymph nodes were evaluated according to the following parameters: size, shape, border demarcation, and central echo pattern. Sensitivity and specificity of endosonography in detecting lymph node metastasis were 89.1% and 91.7%, respectively, when stringent criteria were used. When lymph nodes were imaged endosonographically, regardless of the specific features, the likelihood of N1 disease was 86%, whereas when no lymph nodes were imaged, the chance of N0 disease was 79%. Endosonographic features predictive of malignancy in increasing order of importance were echo-poor (hypoechoic) structure, sharply demarcated borders, rounded contour, and size greater than 10 mm. Collectively, the EUS features produced an additive effect with respect to accuracy in the prediction of malignant lymph node involvement; malignancy could be predicted with 100% accuracy when all four features were present. These results demonstrate that a careful and systematic approach to the endosonographic assessment of lymph node metastasis can improve staging accuracy. (Gastrointest Endosc 1994;40:442-6)

Section snippets

METHODS

A total of 186 consecutive patients underwent preoperative evaluation consisting of EUS, barium swallow x-rays, and computed tomography (CT) during a period of 42 months. Of these, 100 (72 men and 28 women; age range, 48 to 78 years; mean, 69 years) underwent surgical resection and are included in this study. The presence of esophageal carcinoma was confirmed by standard endoscopic biopsies performed in all patients before surgery. Patients in whom CT showed evidence of distant metastasis were

RESULTS

One hundred patients with esophageal carcinoma underwent esophageal resection (Table 1). A total of 132 regional lymph nodes were imaged by EUS in 66 patients. In the remaining 34 patients, no lymph nodes were imaged.

Actual lymph node status (benign versus malignant) was highly correlated (p < 0.0001) with endosonographic assessment (Table 2). Of all lymph nodes containing metastasis (N1) (Fig. 3), EUS detected the presence of malignancy in 89.1% (sensitivity).

. Endoscopic ultrasonogram of a

DISCUSSION

The prognosis of esophageal carcinoma remains extremely poor despite advances in chemotherapeutic and surgical management. One reason for the poor prognosis is that the majority of patients have advanced disease at diagnosis. However, those with early-stage disease have significantly higher survival rates after surgical resection. Therefore, accurate staging of esophageal carcinoma is essential to appropriate management.22-26

The American Joint Committee on Cancer (AJCC) in cooperation with the

Acknowledgements

We thank Rosa J. Catalano, RPR, for manuscript preparation.

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    From the Department of Gastroenterology, Biostatistics and Thoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

    ☆☆

    Current address of MVS: University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio.

    Current address of JVD: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

    ★★

    Reprint requests: Marc F. Catalano, MD, Gastroenterology Consultants, LTD., 1333 College Avenue, Racine, WI 53406.

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