Reed C E, Mishra G, Sahai A V, Hoffman B J, Hawes R H
Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Ann Thorac Surg. 1999 Feb;67(2):319-21; discussion 322. doi: 10.1016/s0003-4975(99)00031-4.
Clinical staging of esophageal cancer is required for optimal therapy but remains imprecise. Pathologic verification of involved lymph nodes could potentially direct treatment allocation. With the rising incidence of distal and gastroesophageal junction adenocarcinomas, assessment of the celiac axis lymph nodes (CLNs) becomes important because it is a common nodal drainage basin. Endoscopic ultrasound (EUS) permits evaluation of CLNs and biopsy by fine-needle aspiration. This study examined the usefulness of this staging tool.
A consecutive series of 62 patients with esophageal cancer considered resectable by computed tomographic scan underwent EUS for T and N staging and were retrospectively studied. A CLN visualized by EUS as greater than 5 mm was considered positive. Fine-needle aspiration of the CLN was performed routinely. Endoscopic ultrasound and computed tomographic staging were compared on the basis of pathologic verification of CLNs.
It was possible to evaluate CLNs by EUS in 59 (95%) of 62 patients: positive in 19, negative in 40. In EUS-positive patients, fine-needle aspiration was positive in 15, falsely negative in 2, and not done in 2. By computed tomographic scan, CLNs were negative in 57 patients and positive in 2. The CLNs were positive in 23 of 54 patients eligible for CLN pathologic verification. All positive CLNs not identified by EUS (7 false-negative EUS) were microscopic foci in one or two nodes and were associated with T3 tumors. Sensitivity and specificity of EUS were 72% and 97%, respectively, compared with 8% and 100% for computed tomographic scan. When EUS identified CLNs, fine-needle aspiration confirmed positivity in 88% of cases.
Endoscopic ultrasound with fine-needle aspiration is useful in the detection and confirmation of CLN metastasis. In T3 tumors of the distal esophagus, a negative EUS result does not substantiate absence of CLN disease. Endoscopic ultrasound with fine-needle aspiration may be important in guiding treatment for patients with distal adenocarcinoma and documenting disease before neoadjuvant therapy.
食管癌的临床分期对于优化治疗方案很有必要，但目前仍不够精确。对受累淋巴结进行病理核实可能有助于指导治疗方案的制定。随着远端和胃食管交界腺癌发病率的上升，对腹腔干淋巴结（CLNs）的评估变得尤为重要，因为它是常见的淋巴结引流区域。内镜超声（EUS）可用于评估CLNs并通过细针穿刺进行活检。本研究旨在探讨这种分期工具的实用性。
对连续62例经计算机断层扫描（CT）评估可切除的食管癌患者进行EUS检查，以确定肿瘤的T分期和N分期，并进行回顾性研究。EUS显示直径大于5mm的CLN被视为阳性。常规对CLN进行细针穿刺活检。根据CLN的病理核实结果，比较EUS和CT的分期情况。
62例患者中有59例（95%）可通过EUS评估CLNs：其中19例为阳性，40例为阴性。在EUS检查为阳性的患者中，细针穿刺活检结果为阳性的有15例，假阴性的有2例，未进行活检的有2例。CT检查显示，57例患者CLNs为阴性，2例为阳性。在54例有条件进行CLN病理核实的患者中，23例CLNs为阳性。所有未被EUS检测到的阳性CLNs（7例假阴性EUS结果）均为一两个淋巴结中的微小病灶，且与T3期肿瘤相关。EUS的敏感性和特异性分别为72%和97%，而CT的敏感性和特异性分别为8%和100%。当EUS检测到CLNs时，细针穿刺活检在88%的病例中证实为阳性。
内镜超声联合细针穿刺活检有助于检测和确认CLN转移。对于远端食管T3期肿瘤，EUS结果为阴性并不能排除CLN受累。内镜超声联合细针穿刺活检对于指导远端腺癌患者的治疗以及在新辅助治疗前记录病情可能具有重要意义。
