Neck ultrasound in staging squamous oesophageal carcinoma - A high yield technique

AIM: This study evaluates the use of neck ultrasound in staging squamous oe sophageal carcinoma. MATERIALS AND METHODS: A prospective analysis of the clinical, neck ultraso und (US) and thoraco-abdominal computed tomography (CT) findings in 121 pat ients with squamous oesophageal carcinoma at presentation was performed. Th e relationship between malignant neck nodes, mediastinal and abdominal aden opathy, location and size of the primary tumour was analysed. RESULTS: Ten of 121 patients (8%) had clinically palpable neck nodes which were deemed malignant in six (5%) following US and fine-needle aspiration f or cytology, Of those 111 patients with no palpable neck nodes, 31 (28%) ha d malignant nodes shown on US. The more cephalad the location of the primar y tumour, the higher the frequency of malignant neck nodes which were found in 80%, 52%, 29% and 9% of cervical, upper thoracic, mid-thoracic and lowe r thoracic oesophageal tumours, respectively. Eleven (29%) of the 38 patien ts with malignant neck nodes shown on US had no CT evidence of additional a denopathy in the mediastinum or upper abdomen. Neck US altered TNM staging in 22/121 (18%) patients at presentation. CONCLUSION: Neck US frequently detects clinically impalpable metastatic nod es leading to altered TNM staging in patients with squamous oesophageal car cinoma, We advocate its routine use when staging squamous oesophageal carci noma.