Parmar Kiran S, Zwischenberger Joseph B, Reeves Angela L, Waxman Irving
Department of Surgery, University of Texas Medical Branch at Galveston, USA.
Ann Thorac Surg. 2002 Mar;73(3):916-20; discussion 920-1. doi: 10.1016/s0003-4975(01)03560-3.
The purpose of this study was to determine how endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) with a histology confirmed biopsy protocol impacted on staging and managing esophageal carcinoma in terms of resectability and neoadjuvant therapy (chemotherapy and radiation therapy).
The records of 40 consecutive patients diagnosed with esophageal cancer referred for EUS staging were reviewed. Computed tomography (CT) scan then EUS imaging and EUS-guided FNA staging, including involvement of celiac node (M1a stage), surgical pathology, and subsequent treatment were correlated. Through-the-scope balloons were used for dilatation when needed to examine the celiac nodes.
All 40 patients followed the protocol and were successfully imaged by EUS. Sixteen of the 40 required esophageal dilatation using the through-the-scope balloon. No complications were observed from esophageal dilatation for EUS. Twenty-three (58%) met the criteria for EUS-guided FNA biopsy from a total of 40 EUS imaging procedures. Twenty (87%) of the 23 EUS-guided FNA were directed toward the celiac nodes; 18 (90%) of the 20 were positive for malignancy and were treated by chemoradiation therapy and 2 (10%) FNA were negative for malignancy and were treated by surgical resection. The CT scan was able to detect only 6 (30%) of 20 cases of suspicious celiac lymph nodes, of which 5 (83%) were positive for malignancy by FNA.
EUS-guided FNA of celiac nodes (20 patients) directed management in all patients biopsied. EUS-guided FNA is superior to CT scan for diagnosing M1a disease. Protocol-directed EUS-guided FNA is a pivotal study when used in conjunction with stage-oriented treatment protocols for esophageal carcinoma.
本研究的目的是确定采用组织学确诊活检方案的内镜超声（EUS）引导下细针穿刺抽吸（FNA）在食管癌的可切除性和新辅助治疗（化疗和放疗）方面如何影响分期和管理。
回顾了40例连续诊断为食管癌并接受EUS分期的患者的记录。然后将计算机断层扫描（CT）、EUS成像以及EUS引导下的FNA分期（包括腹腔淋巴结受累情况，即M1a期）、手术病理和后续治疗进行关联分析。必要时使用经内镜球囊进行扩张以检查腹腔淋巴结。
所有40例患者均遵循该方案，且均成功接受了EUS成像检查。40例患者中有16例需要使用经内镜球囊进行食管扩张。EUS引导下的食管扩张未观察到并发症。40例EUS成像检查中，有23例（58%）符合EUS引导下FNA活检标准。23例EUS引导下FNA中有20例（87%）针对腹腔淋巴结；20例中有18例（90%）恶性结果呈阳性，接受了放化疗，2例（10%）FNA恶性结果呈阴性，接受了手术切除。CT扫描仅能检测出20例可疑腹腔淋巴结中的6例（30%），其中5例（83%）FNA恶性结果呈阳性。
EUS引导下对腹腔淋巴结进行FNA（20例患者）指导了所有接受活检患者的治疗。EUS引导下FNA在诊断M1a期疾病方面优于CT扫描。当与食管癌的分期导向治疗方案联合使用时，方案导向的EUS引导下FNA是一项关键研究。
