title: Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Deparment of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. w.a.marsman@amc.uva.nl
authors.forename: W A
authors.initials: WA
authors.lastname: Marsman
authors.forename: M A
authors.initials: MA
authors.lastname: Brink
authors.forename: J J
authors.initials: JJ
authors.lastname: Bergman
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: F J
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: J J
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: P
authors.initials: P
authors.lastname: Fockens
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014463:Ultrasonography