Liu Ji-Bin, Machado Priscilla, Eisenbrey John R, Gummadi Sriharsha, Forsberg Flemming, Wessner Corinne E, Kumar Anand Raman, Chiang Austin, Infantolino Anthony, Schlachterman Alexander, Kowalski Thomas, Coben Robert, Loren David
Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA.
Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA.
Endosc Ultrasound. 2023 Jul-Aug;12(4):362-368. doi: 10.1097/eus.0000000000000001. Epub 2023 Sep 13.
The objective of this pilot study was to compare the performance of contrast-enhanced EUS (CE-EUS)-guided fine-needle aspiration (FNA) with EUS-FNA for lymph node (LN) staging in esophageal cancer.
Thirty-seven subjects with esophageal cancer undergoing EUS staging were enrolled, and 30 completed this institutional review board-approved study. A Prosound F75 US system (Hitachi Medical Systems, Tokyo, Japan) with harmonic contrast imaging software and GF-UCT180 curvilinear endoscope (Olympus, Tokyo, Japan) was utilized. All LNs identified by standard EUS were first noted. Sonazoid (dose: 1 mL; GE Healthcare, Oslo, Norway) was administered peritumorally, and all enhanced LNs were recorded. Fine-needle aspiration was performed on LNs considered suspicious by EUS alone, as well as LNs enhanced on CE-EUS. Performance of each modality was compared using FNA cytology as reference standard.
A total of 132 LNs were detected with EUS, of which 59 showed enhancement on CE-EUS. Fifty-three LNs underwent FNA, and 22 LNs were determined to be malignant. Among the latter, 10 were considered suspicious by EUS, whereas the other 12 LNs underwent FNA only because of CE-EUS enhancement. Contrast-enhanced EUS showed enhancement in 19 of the 22 malignant LNs. The rate of metastatic node identification from EUS was 45% (10/22), and it was 86% (19/22; = 0.008) for CE-EUS. Eight subjects (8/30 [27% of study total]) had nodal status upgraded by the addition of CE-EUS, which influenced LN staging and clinical management.
Fine-needle aspiration of LNs identified by CE-EUS may increase metastasis positive rate by ruling out LNs not associated with the tumor drainage pattern. In addition, CE-EUS seems to identify more metastatic LNs that would not be biopsied under the standard EUS criteria.
本初步研究的目的是比较对比增强超声内镜（CE-EUS）引导下细针穿刺抽吸（FNA）与超声内镜引导下细针穿刺抽吸（EUS-FNA）在食管癌淋巴结（LN）分期中的表现。
纳入37例接受EUS分期的食管癌患者，30例完成了这项经机构审查委员会批准的研究。使用配备谐波对比成像软件的Prosound F75超声系统（日本东京日立医疗系统公司）和GF-UCT180曲线内镜（日本东京奥林巴斯公司）。首先记录标准EUS识别出的所有LN。在肿瘤周围注射声诺维（剂量：1 mL；挪威奥斯陆通用电气医疗集团），记录所有增强的LN。对仅经EUS检查怀疑的LN以及CE-EUS增强的LN进行细针穿刺抽吸。以FNA细胞学检查作为参考标准，比较每种方法的表现。
EUS共检测到132个LN，其中59个在CE-EUS上显示增强。53个LN接受了FNA，22个LN被确定为恶性。在后者中，10个经EUS检查怀疑，另外12个LN仅因CE-EUS增强而接受FNA。对比增强EUS显示22个恶性LN中有19个增强。EUS识别转移淋巴结的比例为45%（10/22），CE-EUS为86%（19/22；P = 0.008）。8例患者（8/30 [占研究总数的27%]）因增加CE-EUS检查而使淋巴结状态升级，这影响了LN分期和临床管理。
对CE-EUS识别出的LN进行细针穿刺抽吸，通过排除与肿瘤引流模式无关的LN，可能会提高转移阳性率。此外，CE-EUS似乎能识别出更多在标准EUS标准下不会进行活检的转移LN。
