title: Assessment for diagnosis of lymph node metastasis in esophageal cancer using endoscopic ultrasound elastography.
abstract: BACKGROUND
  We performed endoscopic ultrasound real-time tissue elastography to more accurately diagnose lymph node metastasis of esophageal cancer. The aim of this study was to evaluate the ability of EUS elastography to distinguish benign from malignant lymph nodes in esophageal cancer patients.
  
  
  METHODS
  The present study had two steps. As the first step (study 1), we developed diagnostic criteria for metastatic lymph nodes using elastography and verified the validity of the criteria. Three hundred and twenty-two lymph nodes from 35 patients treated by surgical resection were included in the study. As the second step (study 2), we preoperatively examined the lymph nodes of esophageal cancer patients with EUS elastography and compared its diagnostic performance with that of the conventional B-mode EUS images. A total of 115 lymph nodes from 31 patients were included.
  
  
  RESULTS
  In study 1, lymph nodes were considered malignant if 50 % or more of the node appeared blue, or if the peripheral part of the lesion was blue and the central part was red/yellow/green. The sensitivity and specificity of the elastography were 79.7 and 97.6 % with an accuracy of 93.8 %, which was significantly higher than the values for conventional B-mode imaging. In study 2, the sensitivity and specificity of the EUS elastography were 91.2 and 94.5 % with an accuracy of 93.9 %, which was also significantly higher than the values for conventional B-mode EUS imaging.
  
  
  CONCLUSIONS
  The present study demonstrated that EUS elastography is useful for diagnosing lymph node metastasis of esophageal cancer.
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Sazuka
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akai
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Uesato
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Horibe
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kuboshima
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kitabayashi
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Akinao
authors.initials: A
authors.lastname: Matsunaga
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kagaya
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Muto
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Takeshita
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Miyazawa
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Shiratori
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Tsuguaki
authors.initials: T
authors.lastname: Kono
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Akutsu
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Hoshino
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
keywords: Diagnosis; EUS elastography; Esophageal cancer; Lymph node; Metastasis