Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands.
Dis Esophagus. 2012 Aug;25(6):555-9. doi: 10.1111/j.1442-2050.2011.01289.x. Epub 2011 Dec 9.
One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan.
术前影像学检查在食管癌患者中的一个目标是检测颈部淋巴结转移。传统上，颈部外部超声检查与计算机断层扫描（CT）相结合，以提高颈部转移的检测率。一般来说，与 CT 或 PET 相比，正电子发射断层扫描-计算机断层扫描（PET-CT）在分期方面显示出更好的效果，因此可能会限制颈部外部超声检查的作用。本研究旨在确定颈部外部超声检查对 PET-CT 的额外价值。这项研究包括所有被转诊到我们中心治疗食管癌的患者。进行诊断分期以确定治疗计划。通过颈部外部超声检查和 PET-CT 评估颈部淋巴结。如果颈部外部超声检查或 PET-CT 怀疑有淋巴结，进行细针抽吸（FNA）检查。在 2008 年至 2010 年期间，195 名被转诊的患者中有 170 名接受了颈部外部超声检查和 PET-CT 检查。在所有患者中，84%的患者被诊断为食管下段或以下的肿瘤。在 170 名患者中，140 名患者的颈部区域没有可疑病变，没有进行 FNA 检查。在 170 名患者中，有 7 名患者的 PET-CT 和颈部外部超声检查均怀疑有淋巴结。在这 7 名患者中，有 5 名患者的淋巴结细胞学检查证实为恶性，有 1 名患者为良性，1 名患者未进行 FNA 检查；排除行食管癌切除术是基于腹腔内转移。在 170 名患者中，有 1 名患者的 PET-CT 显示可疑淋巴结，同时外部超声检查为阴性；这些淋巴结的细胞学检查为良性。在 170 名患者中，有 22 名患者的 PET-CT 为阴性，而颈部外部超声检查怀疑有淋巴结。在这 22 名患者中，有 18 名患者的颈部淋巴结细胞学检查证实为良性，有 4 名患者的 FNA 检查不可行或结果不确定。在中位术后随访 15 个月时，只有 1%的患者发生颈部淋巴结转移。本研究表明，在阴性的 PET-CT 检查结果中，颈部外部超声检查没有额外的价值。根据我们的结果，可以在初步检查中省略它。但是，如果会改变治疗计划，PET-CT 检查中怀疑的淋巴结应通过 FNA 进行确认，以排除假阳性。
