MINIMALLY INVASIVE SURGICAL STAGING IS SUPERIOR TO ENDOSCOPIC ULTRASOUND IN DETECTING LYMPH-NODE METASTASES IN ESOPHAGEAL CANCER

Objective: Endoscopic ultrasonography is frequently used to locally st age esophageal cancer, but few studies exist to validate its accuracy for lymph node metastases. Our objective was to compare endoscopic ult rasonography with video-assisted thoracoscopic and laparoscopic stagin g in evaluating lymph node metastases in esophageal cancer, Methods: T wenty-six patients with potentially resectable esophageal cancer were identified by conventional imaging, Endoscopic ultrasonography was per formed followed by laparoscopic and thoracoscopic staging, and locoreg ional staging was compared, Results: In eight patients endoscopic ultr asonography indicated NO disease, but laparoscopy and thoracoscopy doc umented N1 disease in six, In five of 26 (19%) obstruction prevented e ndoscopic ultrasonography; three had N1 by laparoscopy and thoracoscop y, Thirteen patients had N1 disease according to endoscopic ultrasonog raphy, and 12 of 13 (92%) had N1 disease by laparoscopy and thoracosco py. The sensitivity and specificity of endoscopic ultrasonography for nodal evaluation were 65% and 66%, respectively, Sensitivity decreased to 44% for lymph node metastases less than 1 cm, No instances of T4 d isease were found by surgical staging when endoscopic ultrasonography indicated T3 disease, Endoscopic ultrasonography revealed no distant m etastases in any patient, but in four of 26 (15%) laparoscopy identifi ed liver metastases. Conclusions: The accuracy of endoscopic ultrasono graphy in the diagnosis of lymph node metastases in esophageal cancer was 65% and only 44% for lymph node metastases less than 1 cm diameter , Laparoscopy and thoracoscopy improved the accuracy of staging lymph node metastases in esophageal cancer and had the advantage of evaluati ng the thoracic and abdominal cavities for metastases.