Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction.
OBJECTIVE
To evaluate the value of external ultrasonography (US) of the neck in current dedicated preoperative staging of patients with cancer of the esophagus and gastroesophageal junction (GEJ).


METHODS
We analyzed 180 consecutive patients (154 men, 26 women, and mean age 63 (38-84) years) without palpable cervical lymphadenopathy, treated between January 2001 and March 2006. Suspicious lesions were confirmed by cytological examination. All first 125 consecutive patients (group A) were staged by standard endoscopic ultrasonography (EUS), multidetector computed tomography (md-CT), positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) and external US. The other 55 patients (group B) were prospectively staged according to a revised protocol consisting of routine EUS and md-CT, while PET was only performed in subjects with T3-T4 and/or N1 disease and external US solely on indication.


RESULTS
Cervical metastases were found in seven patients from group A (6%) and in five from group B (9%). Twenty percent (4/20) of the tumors above the carina and 5% (8/160) of the distal tumors presented with cervical metastases. All were diagnosed as T3 and T4 tumors on EUS. Eleven of these metastases were detected by external US and nine on md-CT. All nodal metastases were detected by the combination of PET and md-CT. No cervical metastases were missed by the diagnostic algorithm in group B.


CONCLUSIONS
In present staging procedures for esophageal cancer, routine external US seems to have no additional value in detecting cervical metastases. It is still indicated to obtain cytological proof of suspected cervical lesions.
Department of Surgical Oncology/Abdominal Surgery, University Medical Center Groningen , University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. l.m.a.schreurs@chirs.umcg.nl
Liesbeth M A
LM
Schreurs
Christian C P M
CC
Verhoef
Erik J
EJ
van der Jagt
Gooitzen M
GM
van Dam
Henk
H
Groen
John Th M
JT
Plukker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D014463:Ultrasonography