34. Esophageal Cancer Staging: Improved Accuracy by Endoscopic Ultrasonography of Celiac Lymph Nodes

Carolyn E. Reed, Girish Mishra, Anand Sahai, Brenda J. Hoffman, Robert H. Hawes

Medical University of South Carolina

Charleston, S.C.

Clinical staging of esophageal cancer is required to optimal therapy, but has been an elusive goal. Patients with involvement of celiac lymph nodes (CLNs), indicating advanced disease, are candidates for neoadjuvant protocols. Endoscopic ultrasonography (EUS) permits evaluation of CLNs and biopsy by fine needle aspiration (FNA). We have studied the usefulness of this staging tool.

Methods: We retrospectively studied a consecutive series (1/94-4/98) of 56 patients (48 males, 8 females) with esophageal cancer. Histology was adenocarcinoma in 237, squamous cell in 18, and adenosquamous in 1. All were considered resectable by CT scan and also underwent EUS for T and N staging. Any CLN visualized by EUS were considered positive. EUS and CT staging were compared to surgical results.

Results: It was possible to evaluate CLNs by EUS in 53 of 56 patients (95 percent)- negative in 41, positive in 12. In EUS positive patients, FNA was positive in nine, was falsely negative in one, and was not performed in two. By CT scan, CLNs were negative in 51 patients, positive in two. At surgery, 19/52 specimens had positive CLNs. All positive CLNs not identified by EUS (seven false negative EUS) were microscopic foci in one of two nodes and were associated with T3 tumors. No false negative EUS occurred with T1 or T2 tumors. CT sensitivity was 53 percent, specificity 100 percent. Sensitivity of EUS was 73 percent, specificity 97 percent).

Conclusions: EUS with FNA is useful in the detection and confirmation of CLN metastasis. In T3 tumors of the distal esophagus, a negative EUS does not substantiate absence of celiac nodal disease. EUS with FNA may prove to be critically important in guiding treatment of patients with distal adenocarcinomas and in documenting involved CLNs prior to preoperative neoadjuvant therapy. It may provide baseline information against which effectiveness of treatment can be measured.