Endosonographic features predictive of lymph node metastasis☆,☆☆,★,★★,♢,♢♢
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).
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.
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Current address of MVS: University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Current address of JVD: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Reprint requests: Marc F. Catalano, MD, Gastroenterology Consultants, LTD., 1333 College Avenue, Racine, WI 53406.
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