Doldi S B, Lattuada E, Zappa M A, Cioffi U, Pieri G, Massari M, De Simone M, Peracchia A
Department of General and Oncologic Surgery, Padiglione Monteggia, Ospedale Maggiore Policlinico, Milan, Italy.
Abdom Imaging. 1998 May-Jun;23(3):275-7. doi: 10.1007/s002619900338.
The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach.
We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy.
At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer.
In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performed.
检测颈部淋巴结转移在食管癌患者分期中起着重要作用，有助于采取最佳治疗方法。
我们报告了对174例食管癌患者颈部区域进行超声评估的经验。所有病例均可用7.5或10MHz探头进行颈部超声评估，对颈内静脉和锁骨上区域的淋巴结链进行选择性扫描。短径与长径比值（S/L）是检测淋巴结转移的一种有用方法。通过超声引导下细针穿刺活检获得组织病理学诊断。
超声检查时，我们发现18例（10.3%）患者有颈部转移性淋巴结。其中，17例（94.4%）经细针活检细胞学检查证实有颈部转移性淋巴结。长径超过5mm且S/L大于0.5的淋巴结转移发生率高于S/L小于0.5的淋巴结。我们的经验表明，胸段气管隆突上区食管癌患者以及颈段和下段食管癌患者的淋巴结转移发生率较高。
在超声评估淋巴结时，最有用的参数是淋巴结大小、内部回声不均匀性、边缘形态以及器械压迫操作引起的变形。日本食管疾病学会指出的这些标准在进行超声检查时具有较高的敏感性和诊断特异性。
