Endoscopy 2006; 38(8): 825-829
DOI: 10.1055/s-2006-944611
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma

W.  A.  Marsman1, 2 , M.  A.  Brink1 , J.  J.  G.  H.  M.  Bergman1 , G.  N.  J.  Tytgat1 , F.  J.  W.  ten Kate3 , J.  J.  B.  van Lanschot2 , P.  Fockens1
  • 1Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  • 2Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  • 3Dept. of Pathology, Academic Medical Center, Amsterdam, The Netherlands
Further Information

Publication History

Submitted 1 February 2006

Accepted after revision 10 May 2006

Publication Date:
28 August 2006 (online)

Abstract

Background and study aims: Distal esophageal carcinomas can be resected using transthoracic esophagectomy or transhiatal esophagectomy. Accurate diagnosis of subcarinal and supracarinal lymph-node metastases is important for selecting the surgical strategy. The impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on the preoperative diagnosis of subcarinal and supracarinal lymph-node metastases in patients with distal esophageal carcinoma was therefore investigated.
Patients and methods: Patients with a resectable distal esophageal carcinoma and subcarinal and/or supracarinal lymph nodes visualized on preoperative EUS were prospectively included. The lymph nodes were sampled using EUS-FNA, and if they were found to have metastases, transthoracic resection was offered; by contrast, patients without metastases were offered a transhiatal resection.
Results: Lymph-node metastases were found with EUS-FNA in 11 of the 48 patients included (23 %). Thirteen patients had suspicious nodes on EUS, in four of whom (31 %) the diagnosis was changed into nonmalignant nodes with FNA. Thirty-five patients had nonsuspicious nodes on EUS, in three of whom (9 %) the FNA procedure revealed malignant cells.
Conclusions: EUS with the addition of the FNA procedure has a significant impact on decision-making in patients with esophageal carcinoma in whom transhiatal esophagectomy would otherwise be planned.

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W. A. Marsman, M. D.

Dept. of Gastroenterology

Academic Medical Center · Suite S1-172 · Meibergdreef 9 · 1105 AZ Amsterdam · The Netherlands

Phone: +31-20-5668161

Fax: +31-20-5669190 ·

Email: w.a.marsman@amc.uva.nl