ULTRASONOGRAPHIC DETECTION OF LYMPH-NODE METASTASES IN SUPERFICIAL CARCINOMA OF THE ESOPHAGUS

Background and Study Aims: The presence or absence of lymph-node metas tasis is the single most important factor in determining the strategy for treating superficial carcinoma of the esophagus, In this study, ul trasound (US) and endoscopic ultrasonography (EUS) were used in the di agnosis of lymph-node metastases, and the accuracy and limitations of these methods were assessed. Patients and Methods: Prospectively, 37 p atients with superficial esophageal cancer were studied by US and EUS before surgery, and the results were compared with the histological fi ndings. Twelve of the patients had histologically confirmed lymph-node metastases. Ultrasonographic images of the lymph nodes were classifie d into three types, based on their boundaries and internal echoes. Res ults: The sensitivity, specificity, and accuracy of predicting mediast inal lymph-node metastasis by EUS diagnosis were 80.0%, 87.5%, and 86. 5%, respectively. The sensitivity specificity, and accuracy of US in t he assessment of cervical and abdominal lymph-node metastasis were 71. 4%, 86.7%, and 83.3%, respectively. In cases in which there was a soli tary metastatic lymph node, the detection rate was higher than in case s with two or more positive nodes, R-lost metastatic lymph nodes corre ctly diagnosed by US and EUS were larger than 6 mm and had tumor invol ving more than one-third of their cross-sectional area. Conclusions: I n patients with superficial esophageal carcinomas, US is accurate in s taging cervical and abdominal lymph nodes. EUS is accurate in staging mediastinal lymph nodes.