Evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma: accuracy of EUS

Background.. Endosonography (EUS) is the most accurate modality for assessi ng depth of tumor invasion and local lymph node metastasis. However, its ac curacy in the identification of metastatic (celiac axis) lymph nodes is les s well defined. Our objective in this study was to determine the accuracy of EUS in detecti ng celiac axis lymph node metastasis in patients with esophageal carcinoma. Methods: Two hundred fourteen patients with esophageal carcinoma underwent preoperative EUS. Of these, 145 underwent attempted surgical resection and staging, and 4 underwent EUS-guided fine-needle aspiration of mediastinal a nd celiac lymph nodes. Local (mediastinal) and distant (celiac axis) lymph nodes were assessed for malignancy on the basis of four criteria (larger th an 1 cm, round, homogeneous echo pattern, sharp borders). Accuracy of EUS w as determined by means of correlating histopathologic findings for the rese cted lymph nodes or results of EUS-guided fine-needle aspiration cytologic examination. Results: Surgical exploration (n = 145) and fine-needle aspiration cytologi c examination (n = 4) revealed metastatic celiac axis lymph nodes in 23 and metastatic mediastinal (local) lymph nodes in 93 of 149 patients with esop hageal carcinoma. According to defined criteria for malignant lymph nodes, there were 19 true-positive and 4 false-negative results. Sensitivity for t he diagnosis of celiac lymph node metastasis with EUS was 83% with a 98% sp ecificity. For the diagnosis of mediastinal lymph node metastasis, sensitiv ity was 79% and specificity was 63%. All patients with malignant celiac axi s lymph nodes had local T3 (tumor breaching adventitia) or T4 (tumor invadi ng adjacent organs) disease. Conclusion: EUS is an excellent modality in the evaluation of metastatic ce liac axis lymph nodes in patients with esophageal carcinoma. These findings should be used in selecting options for treatment. Sensitivity for detecti ng malignancy is consistent with that of prior studies, and local and regio nal Lymph nodes and specificity is significantly higher.