Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma.
BACKGROUND
Preoperative identification of lymph node metastases associated with esophageal carcinoma may influence treatment. EUS is the most accurate method for locoregional staging of these tumors. The impact of EUS-guided fine-needle aspiration (EUS-FNA) on lymph node staging in esophageal carcinoma is unclear.


METHODS
From May 1996 to May 1999, 74 patients with esophageal carcinoma underwent preoperative EUS. After October 1998 EUS-guided FNA was performed on nonperitumoral lymph nodes greater than 5 mm in width. The results of EUS with and without FNA were retrospectively reviewed and compared. Final diagnosis was based on surgical results or EUS-guided FNA malignant cytology. Ten of the 74 patients had to be excluded for lack of lymph node stage confirmation. Final diagnosis was obtained in the remaining 64 patients (33 from the EUS only group and 31 from the EUS-FNA group).


RESULTS
The results of EUS versus EUS-FNA for lymph node staging were sensitivity 63% versus 93% (p = 0.01), specificity 81% versus 100% (not significant), and accuracy 70% versus 93% (p = 0.02), respectively. Complications comprised 1 patient who developed self-limited bleeding after dilation that did not preclude completion of the EUS (1%, 95% CI [0%, 7%]).


CONCLUSIONS
EUS-FNA is more sensitive and accurate than EUS alone for preoperative staging of locoregional and celiac lymph nodes associated with esophageal carcinoma. EUS-FNA of nonperitumoral lymph nodes in patients with esophageal carcinoma is safe and should be routinely performed when treatment decisions will be affected by nodal stage.
Vazquez-Sequeiros
E
E
Developmental Endoscopy Unit, Divisions of Gastroenterology and Hepatology, General Thoracic Surgery and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Norton
I D
ID
Clain
J E
JE
Wang
K K
KK
Affi
A
A
Allen
M
M
Deschamps
C
C
Miller
D
D
Salomao
D
D
Wiersema
M J
MJ
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity