Distant lymph node metastases in esophageal cancer: Impact of endoscopic ultrasound-guided biopsy

Background and Study Aims: The aim of this retrospective study was to evalu ate the impact of endoscopic ultrasound (EUS)-guided biopsy in patients wit h esophageal carcinoma where distant lymph nodes which were possibly metast atic were visualized using EUS, Patients and Methods: Out of 198 patients (150 men, mean age 66 years) exam ined over a 4-year period by EUS for local staging of esophageal cancer (12 1 squamous cell carcinomas and 77 adenocarcinomas), there was EUS visualiza tion of distant lymph nodes in 40 (20 %). EUS-guided biopsy was carried out in the latter patients, of cervical nodes with mediastinal tumors (n = 19) , of celiac nodes with cervical tumors (n = 2) or superior mediastinal tumo rs (n = 9), and upper mediastinal lymph nodes in the case of distal adenoca rcinomas (n = 10), Results: On EUS-guided biopsy, results were positive in 31 patients, eight were correctly negative (as confirmed by surgery), and in one patient there was a technical failure, with positive findings on subsequent surgery. The sensitivity and specificity of the diagnosis of malignant lymph nodes were therefore 97% and 100% respectively. The positive results of EUS-guided bi opsy modified the tumor staging in 31 of these cases (77.5%), proving dista nt lymph node metastasis which is classified as stage M1. With regard to ac tual clinical management, surgery was withheld from 24 patients (60% of 40 cases) who were then treated with concomitant radiotherapy and chemotherapy . Conclusion: EUS-guided biopsy of distant lymph nodes was indicated in 20% o f patients with esophageal cancers, and the biopsy results led to upgrading of the tumor stage in about 80% of cases and influenced the treatment deci sion in about 60%.