title: The utility of EUS and EUS-guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: a single-center experience.
abstract: BACKGROUND
  The aims of this study were to determine the utility of EUS and EUS-guided fine needle aspiration (EUS-FNA) in the detection and confirmation of celiac lymph node metastasis in patients with esophageal cancer and to define EUS features predictive of celiac lymph node metastasis in these patients.
  
  
  METHODS
  The records of 211 patients with esophageal cancer who underwent EUS staging were reviewed. The operating characteristics of EUS were determined in patients where either surgery, EUS-FNA of a celiac lymph node, or both were performed (n = 102). The association between selected variables and the presence of celiac lymph node metastasis was evaluated by univariate and multivariable analyses.
  
  
  RESULTS
  EUS in 48 patients provided a true-positive diagnosis of celiac lymph node involvement, a false-positive and false-negative result, respectively, in 6 and 14 patients, and a true-negative diagnosis in 34 patients. The sensitivity of EUS in detecting celiac lymph node was 77% (95% CI [67, 88]), specificity 85% (95% CI [74, 96]), negative predictive value 71% (95% CI [58, 84]), and the positive predictive value 89% (95% CI [81, 97]). EUS-FNA was performed in 94% (51/54) of patients with celiac lymph nodes. The accuracy of EUS-FNA in detecting malignant celiac lymph nodes was 98% (95% CI [90, 100]). Advanced T-stage, the need for dilation, detection of peritumoral lymph nodes, and black race were associated with celiac lymph node involvement. In multivariable analysis, advanced T-stage was the strongest predictor of celiac lymph node involvement.
  
  
  CONCLUSIONS
  EUS and EUS-FNA are highly accurate in detecting and confirming celiac lymph nodes metastasis. Depth of tumor invasion as assessed by EUS is a strong predictor of celiac lymph node metastasis in patients with esophageal cancer.
authors.affiliation: Division of Gastroenterology and Hepatology/Digestive Disease Center, The Department of Thoracic Surgery, the Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: M B
authors.initials: MB
authors.lastname: Wallace
authors.forename: C E
authors.initials: CE
authors.lastname: Reed
authors.forename: N
authors.initials: N
authors.lastname: Hadzijahic
authors.forename: D N
authors.initials: DN
authors.lastname: Lewin
authors.forename: A
authors.initials: A
authors.lastname: Van Velse
authors.forename: M B
authors.initials: MB
authors.lastname: Leveen
authors.forename: B
authors.initials: B
authors.lastname: Etemad
authors.forename: K
authors.initials: K
authors.lastname: Matsuda
authors.forename: R S
authors.initials: RS
authors.lastname: Patel
authors.forename: R H
authors.initials: RH
authors.lastname: Hawes
authors.forename: B J
authors.initials: BJ
authors.lastname: Hoffman
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D019160:Endosonography / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric