title: Additional value of external ultrasonography of the neck after CT and PET scanning in the preoperative assessment of patients with esophageal cancer.
abstract: BACKGROUND
  Lymphatic dissemination of a (non-cervical) esophageal tumor to the neck is generally considered as distant metastasis. The aim of this study was to determine the additional value of external ultrasonography (US) to detect lymphatic metastasis to the neck after normal CT scan (CT) with or without normal PET scan (PET).
  
  
  METHODS
  Between January 2003 and December 2005, 306 patients were analyzed for esophageal cancer in our department. A total of 233 patients underwent both CT and external US of the neck. PET was performed in 109 of these patients as part of a prospective cohort study. Fine needle aspiration (FNA) was only performed if external US reported suspected lymph nodes. FNA was defined as gold standard.
  
  
  RESULTS
  In 176 patients (76%), CT did not identify any suspected nodes, but external US disagreed in 36 of them. In 9 of these patients, FNA confirmed metastasis, resulting in an additional value of external US after normal CT scanning of 5% (9/176). In 74 patients (68%), CT and PET did not identify any suspected nodes, but external US disagreed in 11 of them. In 3 of these patients, FNA confirmed metastasis, resulting in an additional value of external US after normal CT and PET of 4% (3/74).
  
  
  CONCLUSIONS
  Considering its minimal invasiveness and wide availability in combination with the importance of the potential therapeutic consequences, we conclude that external US of the neck should be part of the routine diagnostic work-up in patients with esophageal cancer, even after normal CT and PET scanning.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. j.m.omloo@amc.uva.nl
authors.forename: J M T
authors.initials: JM
authors.lastname: Omloo
authors.forename: M
authors.initials: M
authors.lastname: van Heijl
authors.forename: N J
authors.initials: NJ
authors.lastname: Smits
authors.forename: S S K S
authors.initials: SS
authors.lastname: Phoa
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: G W
authors.initials: GW
authors.lastname: Sloof
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D011300:Preoperative Care; D014463:Ultrasonography