Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma.
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.
Marsman
W A
WA
Deparment of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. w.a.marsman@amc.uva.nl
Brink
M A
MA
Bergman
J J
JJ
Tytgat
G N
GN
ten Kate
F J
FJ
van Lanschot
J J
JJ
Fockens
P
P
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