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DOI: 10.1055/s-1999-60
Distant Lymph Node Metastases in Esophageal Cancer: Impact of Endoscopic Ultrasound-Guided Biopsy
Publication History
Publication Date:
31 December 1999 (online)
![](https://www.thieme-connect.de/media/endoscopy/199907/lookinside/thumbnails/10.1055-s-1999-60-1.jpg)
Background and Study Aims: The aim of this retrospective study was to evaluate the impact of endoscopic ultrasound (EUS)-guided biopsy in patients with esophageal carcinoma where distant lymph nodes which were possibly metastatic were visualized using EUS.
Patients and Methods: Out of 198 patients (150 men, mean age 66 years) examined over a 4-year period by EUS for local staging of esophageal cancer (121 squamous cell carcinomas and 77 adenocarcinomas), there was EUS visualization of distant lymph nodes in 40 (20 %). EUS-guided biopsy was carried out in the latter patients, of cervical nodes with mediastinal tumors (n = 19), of celiac nodes with cervical tumors (n = 2) or superior mediastinal tumors (n = 9), and upper mediastinal lymph nodes in the case of distal adenocarcinomas (n = 10).
Results: On EUS-guided biopsy, results were positive in 31 patients, eight were correctly negative (as confirmed by surgery), and in one patient there was a technical failure, with positive findings on subsequent surgery. The sensitivity and specificity of the diagnosis of malignant lymph nodes were therefore 97 % and 100 % respectively. The positive results of EUS-guided biopsy modified the tumor staging in 31 of these cases (77.5 %), proving distant lymph node metastasis which is classified as stage M1. With regard to actual clinical management, surgery was withheld from 24 patients (60 % of 40 cases) who were then treated with concomitant radiotherapy and chemotherapy.
Conclusion: EUS-guided biopsy of distant lymph nodes was indicated in 20 % of patients with esophageal cancers, and the biopsy results led to upgrading of the tumor stage in about 80 % of cases and influenced the treatment decision in about 60 %.
Buts de l'étude: Le but de cette étude rétrospective a été d'évaluer l'impact de la biopsie guidée sous échoendoscopie (EE) de patients présentant un cancer de l'oesophage chez qui l'EE avait mis en évidence des ganglions distaux pouvant être potentiellement des métastases.
Patients et Méthodes: Parmi les 198 patients (150 hommes, âge moyen 66 ans) ayant eu une EE pour le staging d'un cancer de l'oesophage (121 carcinomes épidermoïdes, 77 adénocarcinomes) durant une période de 4 ans, 40 présentaient des ganglions distaux (20 %). Parmi ces patients, une biopsie guidée sous EE a été réalisée en cas de ganglions cervicaux pour des tumeurs médiastinales (n = 19), en cas de ganglions coeliaques pour des cancers cervicaux (n = 2) ou pour des lésions médiastinales supérieures (n = 9) et enfin en cas de ganglions médiastinaux supérieurs pour les adénocarcinomes du l'oesophage inférieur (n = 10).
Résultats: La biopsie sous EE a été positive dans 31 cas, négative (lymphocytes normaux) dans 8 cas (confirmé chirurgicalement). Dans 1 cas la biopsie n'a pas été contributive et le ganglion était métastatique lors de la résection chirurgicale. La sensibilité et la spécificité pour le diagnostic de malignité des ganglions ont été respectivement de 97 et 100 %. Le stade tumoral a été modifié par la biopsie guidée sous EE dans 31 cas (77.5 %), ces tumeurs etant classées M1, et 24 patients (60 % des 40 patients) ont été récusés pour une résection chirurgicale et ont été traités par une radio-chimiothérapie concomitante.
Conclusion: Dans cette étude une biopsie guidée sous EE de ganglions distaux a été indiquée dans 20 % des cas pour des patients porteurs d'un cancer de l'oesophage. Le résultat de la biopsie guidée sous EE a modifié le staging tumoral et la décision thérapeutique dans 80 et 60 % des cas respectivement.
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M. GiovanniniM.D.
Paoli-Calmettes Institute
232 bd Ste-Marguerite
13273 Marseilles Cedex 9
France
Phone: + 33-4-91223650
Email: hdjchir@marseille.fnclcc.fr