Endoscopic Ultrasonography for the Detection of Lymph Node Metastasis in Superficial Esophageal Carcinoma

Autor: Masahiro Fujita, Masahiro Asaka, Yuichi Shimizu, Tomohiko Nakasato, Mitsuru Kawarazaki, Masao Hosokawa, Kiyomi Mera, Hiroyuki Tsukagoshi, Yutaka Watanabe, Masanori Oohara, Mitsuharu Takamasa
Rok vydání: 1997
Předmět:
Zdroj: Digestive Endoscopy. 9:178-182
ISSN: 1443-1661
0915-5635
DOI: 10.1111/j.1443-1661.1997.tb00483.x
Popis: Preoperative diagnosis of lymph node metastasis is a very important factor in determining treatment for patients with superficial esophageal carcinoma (SEC), in terms of whether or not extensive lymphadenectomy is necessary. To evaluate the usefulness of endoscopic ultrasonography (EUS) for the diagnosis of lymph node metastasis, we compared preoperative EUS findings with postoperative histological findings of resected lymph nodes in 82 patients with SEC who underwent extensive lymphadenectomy. The regional lymph nodes of the esophagus were divided into seven areas, and the capability to diagnose the presence or absence of metastatic lymph nodes was evaluated for each area. The sensitivity of EUS in the detection of metastatic lymph nodes was 48.6% overall, which was less than satisfactory, and the positive predictive value was 72.0% overall. However, we obtained relatively good sensitivity (63.6%) in the upper mediastinal area, which had the highest frequency of metastasis (42% of cases with metastatic lymph nodes); the status of this area has a major influence on prognosis and the risk of postoperative complications. In conclusion, we should recognize that EUS findings suggesting the absence of positive nodes do not provide conclusive evidence and only allow the risk of remaining metastatic nodes to be reduced by approximately one half. Other factors, such as the depth of invasion, as well as the findings of percutanous echography and CT, must be comprehensively evaluated. On the other hand, in patients in whom positive nodes are suspected on EUS, the findings can be regarded as being fairly reliable; therefore, esophagectomy with lymph node dissection should be performed even in SEC. In such cases, EUS findings in the upper mediastinal area may be a good index of the suitability of minimally invasive surgery.
Databáze: OpenAIRE
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