Ultrasonic detection of lymph node metastases in the region around the celiac axis in esophageal and gastric cancer.

The celiac axis could be visualized with ultrasound in 140 out of 166 cases (84%). Failure to identify the celiac axis was associated with extensive metastases to the celiac lymph nodes in 73% (19/26) of these cases. The location of lymph nodes in this region could be determined using the celiac axis and its branches as land marks. Celiac lymph nodes can be roughly classified into three types: Type 1--unclear margins and relatively uniform diffuse internal echoes, Type 2--clear margins and weak internal echoes, and Type 3--clear margins and scattered, large internal echoes, frequently seen with notchings. Metastases in celiac lymph nodes were found in 53 of 166 cases, based on histological examination of surgically removed nodes. A preoperative ultrasonic examination indicated lymph node metastases in 39 out of the 53 cases (sensitivity of 74%) and no lymph node metastases in 108 of the remaining 113 cases (specificity of 96%). Most lymph nodes with metastases were of Types 2 or 3. The longer the diameter of the lymph node or the larger the ratio of metastatic area to node cross-sectional area, the higher the detection rate tended to be. These results indicate that ultrasound can be very useful in screening patients for celiac lymph node metastases.