title: Endosonographic detection of mediastinal lymph node metastasis in superficial carcinoma of the esophagus: assessment by type classification and histogram.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS) has been shown to be useful for detecting lymph node metastasis in esophageal cancer. The evaluation of nodal metastasis requires both objective and subjective analyses. In the present study, mediastinal lymph nodes in superficial esophageal carcinoma (SEC) were examined by both EUS appearance and histography, using NIH image software.
  
  
  METHODS
  One hundred and seventy-one lymph nodes of 56 patients with SEC were detected by EUS. These lymph nodes were diagnosed by type classification, based on boundary and internal echo, and by the construction of internal echo histograms using NIH image software. The results were compared with the histological findings.
  
  
  RESULTS
  . The sensitivity, specificity, and accuracy in assessing mediastinal lymph node metastasis by type classification were 83.3%, 88.2%, and 87.7%, respectively. The mean and SD of the histogram correlated well with histological findings and type classification ( P < 0.0001). All lymph nodes with a mean value of less than 185 of the histogram were negative nodes. When positive nodes by type classification were reevaluated according to the threshold value of 185 using the histogram, the sensitivity, specificity, and accuracy improved to 83.3%, 100%, and 98.2%, respectively.
  
  
  CONCLUSIONS
  Type classification assisted by histography improved the diagnostic accuracy of mediastinal lymph node metastasis in SEC.
authors.affiliation: The First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Sakamoto
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Heiji
authors.initials: H
authors.lastname: Yoshinaka
authors.forename: Mario
authors.initials: M
authors.lastname: Shimada
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Owaki
authors.forename: Shizuo
authors.initials: S
authors.lastname: Nakano
authors.forename: Masamichi
authors.initials: M
authors.lastname: Baba
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008875:Middle Aged; D012680:Sensitivity and Specificity