ULTRASONOGRAPHIC EVALUATION OF THE CERVICAL LYMPH-NODES IN PREOPERATIVE STAGING OF ESOPHAGEAL NEOPLASMS

Background: The detection of cervical lymph node metastases plays an i mportant role in staging of patients affected by esophageal cancer to perform the best therapeutic approach. Methods: We report our experien ce concerning the ultrasound evaluation of the cervical area in 174 pa tients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selec tive scanning of the lymph node chains of the internal jugular veins a nd supraclavicular regions. The short-to-long axis ratio (S/L) was a u seful way to detect lymph node metastasis, Histopathologic diagnoses w ere obtained by sonographically guided fine-needle aspiration biopsy. Results: At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervica l lymph nodes confirmed by cytology from fine-needle biopsy. Lymph nod e exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5, Our experie nce shows a high incidence of lymph node metastases in patients with e sophageal cancer localized to the thoracic supracarinal tract and in p atients with cervical and lower esophageal cancer. Conclusion: In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, a nd the deformation caused by compressive instrumental manipulation. Th ese criteria, indicated by the Japanese Society for Esophageal Disease s, yield a high sensitivity and diagnostic specificity when the ultras onographic studies are performed.