Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma

• Published in: Endoscopy Vol. 38; no. 8; p. 825
• Main Authors: Marsman, W A, Brink, M A, Bergman, J J, Tytgat, G N, ten Kate, F J, van Lanschot, J J, Fockens, P
• Format: Journal Article
• Language: English
• Published: Germany 01.08.2006
• Subjects: Biopsy, Needle - methods; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Ultrasonography
• ISSN: 0013-726X
• DOI: 10.1055/s-2006-944611

Distal esophageal carcinomas can be resected using transthoracic esophagectomy or transhiatal esophagectomy. Accurate diagnosis of subcarinal and supracarinal lymph-node metastases is important for selecting the surgical strategy. The impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on the preoperative diagnosis of subcarinal and supracarinal lymph-node metastases in patients with distal esophageal carcinoma was therefore investigated. Patients with a resectable distal esophageal carcinoma and subcarinal and/or supracarinal lymph nodes visualized on preoperative EUS were prospectively included. The lymph nodes were sampled using EUS-FNA, and if they were found to have metastases, transthoracic resection was offered; by contrast, patients without metastases were offered a transhiatal resection. Lymph-node metastases were found with EUS-FNA in 11 of the 48 patients included (23 %). Thirteen patients had suspicious nodes on EUS, in four of whom (31 %) the diagnosis was changed into nonmalignant nodes with FNA. Thirty-five patients had nonsuspicious nodes on EUS, in three of whom (9 %) the FNA procedure revealed malignant cells. EUS with the addition of the FNA procedure has a significant impact on decision-making in patients with esophageal carcinoma in whom transhiatal esophagectomy would otherwise be planned.