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Varga Z, Bíró A, Török M, Tóth D. A combined approach for individualized lymphadenectomy in gastric cancer patients. Pathol Oncol Res 2023; 29:1611270. [PMID: 37456519 PMCID: PMC10338685 DOI: 10.3389/pore.2023.1611270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Introduction: Gastric cancer ranks as the fifth most common cancer globally. The presence of lymph node metastasis is a significant prognostic factor influencing survival. Postoperative morbidity and nodal staging accuracy are heavily affected by the extent of lymph node dissection. Our study aimed to explore the potential integration of two contemporary methods, sentinel node navigation surgery (SNNS) and the Maruyama Computer Program (MCP), to improve the accuracy of nodal staging. Materials and methods: We conducted a prospective data collection involving patients with gastric adenocarcinoma from 2008 to 2018 at the Department of Surgery, University of Debrecen, Hungary. Data from 100 consecutive patients were collected. The primary and secondary endpoints included evaluating the rate of node-negative patients and the diagnostic accuracy of our combined approach. Results: Sentinel node mapping was successful in 97 out of 100 patients. We found that using the threshold value of the Maruyama Index (MI) ≥ 28, all metastatic stations of sentinel-node-negative patients could be identified. Our method achieved 100% sensitivity and negative predictive value, with a specificity of 60.42% (95% CI = 46.31%-72.98%). Discussion: The combined application of SNNS and MCP has proven to be an effective diagnostic technique in the synergistic approach for identifying metastasis-positive lymph node stations. Despite its limitations, this combination may assist clinicians in customizing lymphadenectomy for gastric cancer patients.
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Affiliation(s)
- Zsolt Varga
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Adrienn Bíró
- Department of Surgery, Moritz Kaposi General Hospital, Kaposvár, Hungary
| | - Miklós Török
- Department of Pathology, University of Debrecen, Debrecen, Hungary
| | - Dezső Tóth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
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Amezcua-Hernandez V, Jimenez-Rosales R, Martinez-Cara JG, Garcia-Garcia J, Valverde Lopez F, Redondo-Cerezo E. Preoperative EUS vs. PET-CT Evaluation of Response to Neoadjuvant Therapy for Esophagogastric Cancer and Its Correlation with Survival. Cancers (Basel) 2023; 15:cancers15112941. [PMID: 37296903 DOI: 10.3390/cancers15112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The objective of our study was to investigate whether Endoscopic Ultrasonography (EUS) and Positron Emission Tomography-Computed Tomography (PET-CT) restaging can predict survival in upper gastrointestinal tract adenocarcinomas and to assess their accuracy when compared to pathology. METHODS We conducted a retrospective study on all patients who underwent EUS for staging of gastric or esophago-gastric junction adenocarcinoma between 2010 and 2021. EUS and PET-CT were performed, and preoperative TNM restaging was conducted using both procedures within 21 days prior to surgery. Disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS A total of 185 patients (74.7% male) were included in the study. The accuracy of EUS for distinguishing between T1-T2 and T3-T4 tumors after neoadjuvant therapy was 66.7% (95% CI: 50.3-77.8%), and for N staging, the accuracy was 70.8% (95% CI: 51.8-81.8%). Regarding PET-CT, the accuracy for N positivity was 60.4% (95% CI: 46.3-73%). Kaplan-Meier analysis revealed a significant correlation between positive lymph nodes on restaging EUS and PET-CT with DFS. Multivariate COX regression analysis identified N restaging with EUS and PET-CT, as well as the Charlson comorbidity index, as correlated factors with DFS. Positive lymph nodes on EUS and PET-CT were predictors of OS. In multivariate Cox regression analysis, the independent risk factors for OS were found to be the Charlson comorbidity index, T response by EUS, and male sex. CONCLUSION Both EUS and PET-CT are valuable tools for determining the preoperative stage of esophago-gastric cancer. Both techniques can predict survival, with preoperative N staging and response to neoadjuvant therapy assessed by EUS being the main predictors.
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Affiliation(s)
| | - Rita Jimenez-Rosales
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | | | - Javier Garcia-Garcia
- Department of Oncology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | - Francisco Valverde Lopez
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | - Eduardo Redondo-Cerezo
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
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Kinami S, Saito H, Takamura H. Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis. Front Oncol 2022; 11:806162. [PMID: 35071010 PMCID: PMC8777129 DOI: 10.3389/fonc.2021.806162] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
The stomach exhibits abundant lymphatic flow, and metastasis to lymph nodes is common. In the case of gastric cancer, there is a regularity to the spread of lymph node metastasis, and it does not easily metastasize outside the regional nodes. Furthermore, when its extent is limited, nodal metastasis of gastric cancer can be cured by appropriate lymph node dissection. Therefore, identifying and determining the extent of lymph node metastasis is important for ensuring accurate diagnosis and appropriate surgical treatment in patients with gastric cancer. However, precise detection of lymph node metastasis remains difficult. Most nodal metastases in gastric cancer are microscopic metastases, which often occur in small-sized lymph nodes, and are thus difficult to diagnose both preoperatively and intraoperatively. Preoperative nodal diagnoses are mainly made using computed tomography, although the specificity of this method is low because it is mainly based on the size of the lymph node. Furthermore, peripheral nodal metastases cannot be palpated intraoperatively, nodal harvesting of resected specimens remains difficult, and the number of lymph nodes detected vary greatly depending on the skill of the technician. Based on these findings, gastrectomy with prophylactic lymph node dissection is considered the standard surgical procedure for gastric cancer. In contrast, several groups have examined the value of sentinel node biopsy for accurately evaluating nodal metastasis in patients with early gastric cancer, reporting high sensitivity and accuracy. Sentinel node biopsy is also important for individualizing and optimizing the extent of uniform prophylactic lymph node dissection and determining whether patients are indicated for function-preserving curative gastrectomy, which is superior in preventing post-gastrectomy symptoms and maintaining dietary habits. Notably, advancements in surgical treatment for early gastric cancer are expected to result in individualized surgical strategies with sentinel node biopsy. Chemotherapy for advanced gastric cancer has also progressed, and conversion gastrectomy can now be performed after downstaging, even in cases previously regarded as inoperable. In this review, we discuss the importance of determining lymph node metastasis in the treatment of gastric cancer, the associated difficulties, and the need to investigate strategies that can improve the diagnosis of lymph node metastasis.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Japan
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi City, Japan
| | - Hitoshi Saito
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi City, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Japan
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Tamanini G, Cominardi A, Brighi N, Fusaroli P, Lisotti A. Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes. World J Gastrointest Oncol 2021; 13:1475-1491. [PMID: 34721779 PMCID: PMC8529915 DOI: 10.4251/wjgo.v13.i10.1475] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
The differential diagnosis between benign and malignant lymph nodes (LNs) has a fundamental role in the characterization and staging of malignant conditions, as well as in subsequent patients’ management. All imaging modalities (i.e. computed tomography and magnetic resonance imaging) rely mainly on size; endoscopic ultrasound (EUS) criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature. The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs, to identify which suspicious LN should require pathological characterization and, finally, to target tissue acquisition. EUS-guided tissue acquisition (EUS-TA) is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’ subsequent management and when no superficial LN is accessible. Since target therapy are currently available (i.e. lung cancer, breast cancer), EUS-TA of malignant LNs could be required to identify tumor biology. In this field, both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity. We finally propose a diagnostic algorithm based on most recent, high-level evidence for the diagnostic approach to suspected LNs assessment.
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Affiliation(s)
- Giacomo Tamanini
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Anna Cominardi
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Nicole Brighi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, FC, Italy
| | - Pietro Fusaroli
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Andrea Lisotti
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
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Yamamiya A, Irisawa A, Kashima K, Kunogi Y, Nagashima K, Minaguchi T, Izawa N, Yamabe A, Hoshi K, Tominaga K, Iijima M, Goda K. Interobserver Reliability of Endoscopic Ultrasonography: Literature Review. Diagnostics (Basel) 2020; 10:E953. [PMID: 33203069 PMCID: PMC7696989 DOI: 10.3390/diagnostics10110953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been applied to the diagnosis of various digestive disorders. Although it has been widely accepted and its diagnostic value is high, the dependence of EUS diagnosis on image interpretation done by the endosonographer has persisted as an important difficulty. Consequently, high interobserver reliability (IOR) in EUS diagnosis is important to demonstrate the reliability of EUS diagnosis. We reviewed the literature on the IOR of EUS diagnosis for various diseases such as chronic pancreatitis, pancreatic solid/cystic mass, lymphadenopathy, and gastrointestinal and subepithelial lesions. The IOR of EUS diagnosis differs depending on the disease; moreover, EUS findings with high IOR and those with IOR that was not necessarily high were used as diagnostic criteria. Therefore, to further increase the value of EUS diagnosis, EUS diagnostic criteria with high diagnostic characteristics based on EUS findings with high IOR must be established.
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Affiliation(s)
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (A.Y.); (K.K.); (Y.K.); (K.N.); (T.M.); (N.I.); (A.Y.); (K.H.); (K.T.); (M.I.); (K.G.)
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Endoscopic Ultrasound in Pediatric Patients With Pancreatobiliary Disease. Surg Laparosc Endosc Percutan Tech 2020; 29:271-274. [PMID: 31259867 DOI: 10.1097/sle.0000000000000673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is one of the greatest advances of the last few decades for the diagnostic and therapeutic approach of gastrointestinal diseases in adults. However, there are limitations to the application of the procedure in the pediatric population. The aim of this study was to describe the diagnostic yield and therapeutic role of EUS in pediatric patients with pancreatobiliary disease. MATERIALS AND METHODS A retrospective study was performed on a prospective database of pediatric patients who underwent diagnostic and therapeutic endosonographic procedures. All patients seen in a 12-year period were included. RESULTS A total of 54 patients were included, including 32 (59.3%) female individuals, with an average age of 16 (9 to 17) years. EUS was abnormal in 46 (85%) patients. Of the abnormal procedures, 4 (7.4%) corresponded to therapeutic ones. The main indication of the study was recurrent acute pancreatitis in 29 (54%). The main endosonographic findings were microlithiasis in 14 (25.9%), chronic pancreatitis in 9 (16.7%), and pancreatic tumors in 6 (11.1%) patients. Follow-up was performed in 31 (57.4%) patients, 19/31 patients underwent surgery, and 4/31 patients had endoscopic retrograde cholangiopancreatography. The median follow-up was 910 (2 to 3916) days. In 100% of the patients with follow-up, the initial diagnosis of EUS was confirmed. CONCLUSION EUS is a useful and safe tool in the pediatric population with pancreatobiliary diseases.
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Junare PR, Jain S, Rathi P, Contractor Q, Chandnani S, Kini S, Thanage R. Endoscopic ultrasound-guided-fine-needle aspiration/fine-needle biopsy in diagnosis of mediastinal lymphadenopathy - A boon. Lung India 2020; 37:37-44. [PMID: 31898619 PMCID: PMC6961103 DOI: 10.4103/lungindia.lungindia_138_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background/Objectives: Evaluation of mediastinal lymphadenopathy (MLA) is a great diagnostic challenge considering the myriad of causes. In recent years, the role of endoscopic ultrasound (EUS) has been greatly extended in evaluation of MLA due to its safety, reliability, and accuracy. The present study details the role of EUS-guided-fine-needle aspiration/fine-needle biopsy (EUS-FNA/FNB) in MLA of unknown origin. Methods: Seventy-two patients (34 men) with MLA of unknown etiology were studied. Mediastinum was evaluated with linear echoendoscope and FNA/FNB was performed with 22-G needle and sent for cytology, histopathological, and mycobacterial growth indicator tube/GeneXpert evaluation. EUS-FNA/FNB diagnosis was based on cytology reporting by pathologists. Patients tolerated the procedure, and insertion of needle into the lesion was always successful without any complications. Results: EUS-FNA/FNB established a tissue diagnosis in 66/72 patients in first sitting, while six patients underwent repeat procedure. EUS-FNA diagnoses (after second sitting) were tuberculous lymphadenitis in 45/72 (62.5%), metastatic lymph nodes 12/72 (16.7%), reactive lymphadenopathy 6/72 (8.3%), sarcoidosis 4/72 (5.6%), and lymphoma 2/72 (2.8%), while it was nondiagnostic in 3/72 (4.1%) patients. Final diagnosis was based on combined clinical presentation, EUS-FNA/FNB result and clinicoradiological response to treatment on long-term follow-up of 6 months. Conclusion: EUS echo features along with EUS-FNA/FNB can diagnose MLA and surgical biopsy can be avoided.
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Affiliation(s)
- Parmeshwar Ramesh Junare
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Samit Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Sangeeta Kini
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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Lisotti A, Ricci C, Serrani M, Calvanese C, Sferrazza S, Brighi N, Casadei R, Fusaroli P. Contrast-enhanced endoscopic ultrasound for the differential diagnosis between benign and malignant lymph nodes: a meta-analysis. Endosc Int Open 2019; 7:E504-E513. [PMID: 31044153 PMCID: PMC6447401 DOI: 10.1055/a-0854-3785] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023] Open
Abstract
Background The differential diagnosis between benign and malignant lymph nodes (LNs) is crucial for patient management and clinical outcome. The use of contrast-enhanced endoscopic ultrasound (EUS) has been evaluated in several studies with diverse results. The aim of this meta-analysis was to evaluate the pooled diagnostic accuracy of contrast-enhanced EUS (CE-EUS) and contrast-enhanced harmonic EUS (CH-EUS) in this setting. Methods A systematic electronic search was performed, including all original papers dealing with assessment of the nature of the LNs using CE-EUS or CH-EUS. A meta-analysis was performed to obtain pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. The Summary Receiver Operating Characteristic (ROC) Curve method was used to calculate the area under the curve. Statistical analysis was carried out using Meta-Disc V.1.4, Stata V.12.0 and Review Manager V.5.2. Results Among 210 pertinent studies, four (336 patients) were included in the analysis. The pooled sensitivity was 82.1 % (75.1 - 87.7 %) and pooled specificity was 90.7 % (85.9 - 94.3 %) with significant heterogeneity found in sensitivity; the positive-likelihood ratio (LR) was 7.77 (5.09 - 11.85) and the negative-LR was 0.15 (0.05 - 0.46); the pooled diagnostic odds ratio (DOR) was 54 (15 - 190). Subgroup analysis including studies performed using CH-EUS (two studies, 177 LNs) showed a pooled sensitivity of 87.7 % (77.0 - 93.9 %) and a pooled specificity of 91.8 % (84.5 % - 96.4 %) with no significant heterogeneity; the pooled positive-LR was 9.51 (4.95 - 18.28) and the pooled negative-LR was 0.14 (0.06 - 0.35); pooled DOR was 68.42 (15.5 - 301.4). Conclusions From these data, CE-EUS is not recommended due to inadequate sensitivity. On the other hand, CH-EUS studies showed optimal accuracy (pooled sensitivity 87.7 % and specificity 91.8 %), comparable to elastography and even EUS-guided fine needle aspiration (EUS-FNA), suggesting a role in the diagnostic algorithm.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Bologna, Italy,Corresponding author Dr Andrea Lisotti, MD Gastroenterology UnitHospital of ImolaDepartment of Medical and Surgical ScienceUniversity of BolognaVia Montericco 440026 Imola (BO)Italy+39-51-6364120
| | - Claudio Ricci
- Department Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marta Serrani
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Bologna, Italy
| | - Claudio Calvanese
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Bologna, Italy
| | - Sandro Sferrazza
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Bologna, Italy
| | - Nicole Brighi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Casadei
- Department Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Bologna, Italy,Department Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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New endoscopic ultrasonography criteria for malignant lymphadenopathy based on inter-rater agreement. PLoS One 2019; 14:e0212427. [PMID: 30794598 PMCID: PMC6386303 DOI: 10.1371/journal.pone.0212427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 02/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aims Various studies have been previously conducted on the diagnosis of lymphadenopathy as benign or malignant, but the results vary. These studies did not describe the inter-rater agreement on the EUS features of lymphadenopathy. In this study, we evaluate the inter-rater agreement on EUS features and propose EUS diagnostic norms for lymphadenopathy based on inter-rater agreement. Method A total of 68 lymph nodes subjected to EUS-fine needle aspiration (FNA) were reviewed by five endoscopic experts. The EUS features evaluated lymph node size, shape, border, margin, echogenicity, homogeneity, and the hilum of the lymph node. Inter-rater agreement (multi-rater kappa statics) was performed. We established new criteria using results with a high degree of inter-rater agreement from EUS features and compared them with the former criteria. Result There was a moderate agreement on shape, kappa (K) = 0.44 (95% confidence interval [CI]: 0.34–0.54), and fair agreement on echogenicity, homogeneity, border, and hilum of the lymph node, K (95% CI) = 0.33 (0.17–0.38), 0.34 (0.26–0.35), 0.22 (0.21–0.31), and 0.22 (0.11–0.26), respectively. This resulted in the establishment of new EUS diagnostic criteria using shape, long axis > 20 mm and short axis > 10 mm. New criteria were superior to old criteria (area under the curve 0.82 vs 0.52, P < 0.001). Conclusion EUS diagnostic criteria for lymphadenopathy based on inter-rater agreement were more accurate than old criteria. This result will be useful for the diagnosis of lymphadenopathy.
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Lee HD, Chung H, Kim SG, Kim J, Kim JL, Lee E, Jung HC. Exploring the possibility of endoscopic submucosal dissection for clinical submucosal invasive early gastric cancers. Surg Endosc 2019; 33:4008-4015. [PMID: 30725253 DOI: 10.1007/s00464-019-06690-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The current standard treatment modality for clinical submucosal invasive (cT1b) early gastric cancer (EGC) is surgery. However, there are discrepancies in T staging between pre- and post-operative findings, and in cases of overestimation, patients may lose the opportunity to preserve the stomach. The aim of this study was to analyze surgical outcomes of cT1b EGC and determine the pre-treatment factors favoring ESD. METHODS Patients who underwent gastrectomy for cT1b EGC with a tumor size of 30 mm or less in diameter and differentiated-type histology were retrospectively reviewed from January 2010 to December 2014. According to the final surgical pathologic results, two groups were classified: patients whose pathologic results qualified for current ESD indication (ESD-qualified group, n = 203) and patients whose pathologic results made them ineligible for ESD (ESD-disqualified group, n = 261). The preoperative clinical characteristics were compared. RESULTS Forty-three percent of the patients (203/464) who underwent gastrectomy for cT1b EGC qualified for ESD; their endoscopic lesion tended to be smaller than 20 mm in size and located in the distal part of stomach. In addition, the ESD-qualified group showed a significantly higher proportion of well-differentiated tubular adenocarcinoma on endoscopic biopsy and of the flat/depressed type in the endoscopic evaluation. CONCLUSION Forty-three percent of the patients with cT1b EGC who underwent gastrectomy had a chance to preserve their stomach by ESD. Therefore, pre-treatment factors such as endoscopic lesion size, location, histology, and gross type should be considered for treatment modality selection for cT1b EGC.
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Affiliation(s)
- Hyun Deok Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jue Lie Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eunwoo Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Wang J, Liu M, Shen J, Ouyang H, Xie X, Lin T, Li A, Yang H. Diagnostic value of intraoperative ultrasonography in assessing thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer. BMC Cancer 2018; 18:737. [PMID: 30005630 PMCID: PMC6045849 DOI: 10.1186/s12885-018-4643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Backgroud The incidence of recurrent laryngeal nerve (RLN) injury has increased due to RLN lymph node dissection. The aim of this study was to evaluate the ability of intraoperative ultrasonography (IU) to detect RLN nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4, 14.3, and 30.0%, respectively, and a significant difference among these three examinations was observed (χ2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4, 97.8, and 95.0%, respectively, and a significant difference was observed (χ2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7, 16.7, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (χ2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2, 100, and 82.5%, respectively and a significant difference was observed (χ2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer.
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Affiliation(s)
- Jianwei Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Min Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Jingxian Shen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Haichao Ouyang
- Shenzhen Seventh People's Hospital, Shenzhen, 518000, China
| | - Xiuying Xie
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Ting Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Anhua Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
| | - Hong Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China. .,Guangdong Esophageal Cancer Institute, Guangzhou, China.
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12
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Redondo-Cerezo E, Martínez-Cara JG, Jiménez-Rosales R, Valverde-López F, Caballero-Mateos A, Jérvez-Puente P, Ariza-Fernández JL, Úbeda-Muñoz M, López-de-Hierro M, de Teresa J. Endoscopic ultrasound in gastric cancer staging before and after neoadjuvant chemotherapy. A comparison with PET-CT in a clinical series. United European Gastroenterol J 2016; 5:641-647. [PMID: 28815027 DOI: 10.1177/2050640616684697] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treatment of gastric cancer is based on accurate staging. Emerging methods, such as PET-CT, are increasingly being used for this purpose. Our aim was to analyze the results of EUS and PET-CT in staging and restaging our patients with gastric cancer, comparing both of them with the histological results. METHODS Patients with confirmed gastric cancer were prospectively enrolled. Inclusion criteria for the final analysis included only patients who finally received a surgical resection. All patients underwent preoperative TNM staging by means of EUS and PET-CT within 21 days prior to the surgical treatment. RESULTS A total of 256 patients were included. The overall EUS accuracy for T staging was 78% and 80.2% in restaging. EUS showed its best accuracy when distinguishing T1-T2 tumors vs. T3-T4, with an increased accuracy in restaging. Regarding N staging, the overall accuracy of EUS was 76.2%, and 72.5% for PET-CT (p = 0.02). With regards to restaging, accuracy of EUS and PET-CT for N staging was 88.5% and 69%, respectively, with significant differences (p < 0.0001). CONCLUSIONS EUS performed better than PET-CT in gastric cancer N staging and restaging. EUS accuracy in this setting is still suboptimal and probably more than one single diagnostic procedure should be used.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Juan Gabriel Martínez-Cara
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Rita Jiménez-Rosales
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Francisco Valverde-López
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Antonio Caballero-Mateos
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Pablo Jérvez-Puente
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Jose Luis Ariza-Fernández
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Margarita Úbeda-Muñoz
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Mercedes López-de-Hierro
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Javier de Teresa
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain
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13
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Kurita A, Kodama Y, Nakamoto Y, Isoda H, Minamiguchi S, Yoshimura K, Kuriyama K, Sawai Y, Uza N, Hatano E, Uemoto S, Togashi K, Haga H, Chiba T. Impact of EUS-FNA for preoperative para-aortic lymph node staging in patients with pancreatobiliary cancer. Gastrointest Endosc 2016; 84:467-475.e1. [PMID: 26970011 DOI: 10.1016/j.gie.2016.02.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/26/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS In patients with pancreatobiliary cancer, para-aortic lymph node (PALN) metastasis is considered to be the involvement beyond the regional lymph nodes, namely, distant metastasis. Effective methods for preoperative PALN staging, however, are not established. This study aimed to compare the diagnostic capability for PALN metastasis between EUS-FNA and (18)F-fluorodeoxyglucose positron emission tomography with CT (PET/CT). METHODS We performed a prospective, nonrandomized, single-center trial. Between December 2010 and March 2014, 208 patients with pancreatobiliary cancer without apparent distant metastasis except for PALNs were assessed for study eligibility before surgery. Among them, 52 consecutive patients with PALN enlargement were enrolled in the study. (18)F-Fluorodeoxyglucose PET/CT and EUS-FNA were performed sequentially as a single combined procedure to evaluate PALN metastases. The primary outcome was to compare the diagnostic capability of EUS-FNA and PET/CT for PALN metastasis. RESULTS Of 71 enlarged PALNs in the 52 patients, 30 (42.3%) were finally diagnosed as metastases in 21 patients (40.4%). Of the 21 patients with PALN metastases, preoperative EUS-FNA or PET/CT made a correct diagnosis in 20 (95.2%) or 12 (57.1%), respectively. EUS-FNA had higher sensitivity and specificity for the diagnosis of PALN metastasis (sensitivity, 96.7% [29/30]; 95% confidence interval, 82.2%-99.9%; specificity, 100% [39/39]; 95% confidence interval, 91.0%-100%) than PET/CT. CONCLUSIONS EUS-FNA is superior to PET/CT for preoperative PALN staging in patients with pancreatobiliary cancer. Because of the clinical benefit of EUS-FNA to reduce unnecessary surgery, it should be part of the standard preoperative examination for patients with pancreatobiliary cancer. (UMIN clinical trials registry number: 000006408.).
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Affiliation(s)
- Akira Kurita
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yuzo Kodama
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan
| | - Katsutoshi Kuriyama
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Sawai
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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14
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Abstract
Elastographic techniques have recently become available as advanced diagnostic tools for tissue characterization. Strain elastography is a real-time technique used with transcutaneous ultrasound (US) and endoscopic US. Convincing evidence is available demonstrating a significant value of strain elastography for the discrimination of benign and malignant lymph nodes (LNs). This paper reviews preliminary data demonstrating the feasibility of performing real-time elastography during endobronchial US (EBUS) and a potential application of this technique for selection of LNs for EBUS-guided transbronchial needle aspiration in patients with lung cancer and extrathoracic malignancies.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus Bad Mergentheim, Uhlandstr, 7, 97980 Bad Mergentheim, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, 15344 Strausberg, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
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15
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Sharma M, Ecka RS, Somasundaram A, Shoukat A, Kirnake V. Endoscopic ultrasound in mediastinal tuberculosis. Lung India 2016; 33:129-34. [PMID: 27051097 PMCID: PMC4797428 DOI: 10.4103/0970-2113.177451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Tubercular lymphadenitis is the commonest extra pulmonary manifestation in cervical and mediastinal locations. Normal characteristics of lymph nodes (LN) have been described on ultrasonography as well as by Endoscopic Ultrasound. Many ultrasonic features have been described for evaluation of mediastinal lymph nodes. The inter and intraobserver agreement of the endosonographic features have not been uniformly established. Methods and Results: A total of 266 patients underwent endoscopic ultrasound guided fine needle aspiration and 134 cases were diagnosed as mediastinal tuberculosis. The endoscopic ultrasound location and features of these lymph nodes are described. Conclusion: Our series demonstrates the utility of endoscopic ultrasound guided fine needle aspiration as the investigation of choice for diagnosis of mediastinal tuberculosis and also describes various endoscopic ultrasound features of such nodes.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Ruth Shifa Ecka
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Aravindh Somasundaram
- Department of Gastroenterology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Vijendra Kirnake
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
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16
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Gogia P, Insaf TZ, McNulty W, Boutou A, Nicholson AG, Zoumot Z, Shah PL. Endobronchial ultrasound: morphological predictors of benign disease. ERJ Open Res 2016; 2:00053-2015. [PMID: 27730169 PMCID: PMC5005152 DOI: 10.1183/23120541.00053-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 12/25/2022] Open
Abstract
The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study. Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied. The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72-0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present. Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.
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Affiliation(s)
- Pratibha Gogia
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK
| | - Tabassum Z Insaf
- School of Public Health University at Albany, State University of New York, Rensselaer, NY, USA
| | - William McNulty
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Afroditi Boutou
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK
| | - Andrew G Nicholson
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Dept of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Zaid Zoumot
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; These authors contributed equally
| | - Pallav L Shah
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; These authors contributed equally
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17
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Kim KH. The roles of endoscopic ultrasound in the diagnosis of pancreatobiliary cancer. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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18
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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19
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Dietrich CF, Jenssen C, Arcidiacono PG, Cui XW, Giovannini M, Hocke M, Iglesias-Garcia J, Saftoiu A, Sun S, Chiorean L. Endoscopic ultrasound: Elastographic lymph node evaluation. Endosc Ultrasound 2015; 4:176-90. [PMID: 26374575 PMCID: PMC4568629 DOI: 10.4103/2303-9027.162995] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives.
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Affiliation(s)
- Christoph F Dietrich
- Department of Medicine, Caritas-Krankenhaus, Uhlandstr, Bad Mergentheim, Germany
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20
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Shan HB, Zhang R, Li Y, Gao XY, Lin SY, Luo GY, Li JJ, Xu GL. Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer. PLoS One 2015; 10:e0137400. [PMID: 26372339 PMCID: PMC4570776 DOI: 10.1371/journal.pone.0137400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. METHODS A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. RESULTS The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. CONCLUSIONS EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture.
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Affiliation(s)
- Hong-Bo Shan
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong Zhang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yin Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Yan Gao
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shi-Yong Lin
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guang-Yu Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Jun Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guo-Liang Xu
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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21
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Jamil LH, Kashani A, Scimeca D, Ghabril M, Gross SA, Gill KRS, Hasan MK, Woodward TA, Wallace MB, Raimondo M. Can endoscopic ultrasound distinguish between mediastinal benign lymph nodes and those involved by sarcoidosis, lymphoma, or metastasis? Dig Dis Sci 2014; 59:2191-8. [PMID: 24801684 DOI: 10.1007/s10620-014-3164-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Lymph nodes (LNs) echofeatures on endoscopic ultrasound (EUS) and concurrent fine needle aspiration (FNA) are alternatives to highly invasive approaches for etiologic diagnosis of mediastinal lymphadenopathy (MLAD). AIMS To evaluate the efficacy of LNs echofeatures and FNA via EUS to distinguish benign LNs from LNs involved by sarcoidosis, lymphoma, and metastasis in non-lung cancer patients. METHODS A retrospective review of patients who underwent EUS-FNA for MLAD was performed. Echofeatures of LNs including echogenicity, margins, shape, and LN size were recorded. Final diagnosis was made based on surgical sampling or clinical diagnosis with long-term follow-up. Only patients diagnosed as benign MLAD, sarcoidosis, lymphoma, and metastasis included. Diagnostic value of echofeatures and FNA was evaluated. RESULTS Included were 162 patients with final diagnosis of benign (68), sarcoidosis (33), lymphoma (20), and metastasis (41). The median LN along axis in the benign group [20.5 mm (6-76)] was significantly shorter than in the metastasis [28 mm (9-82)] and sarcoidosis [27 mm (17-50)] groups (p < 0.05). The median LN short axis in the benign group [11 mm (2-50)] was significantly shorter than in the metastasis [17 mm (5-44)] and lymphoma [16 mm (7-47)] groups (p < 0.05). No other echofeatures showed a discriminant value among the groups. When performing FNA, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 73.7, 100, 100, 72.2, and 84.4 %, respectively. CONCLUSION Although benign MLAD tend to be smaller than other etiologies, echofeatures of LNs are not reliable etiologic diagnostic approach to MLAD. Therefore, FNA is suggested when feasible. However, due to relatively low sensitivity, LNs with benign FNA results should be subjected to further work-up if they are clinically suspicious.
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Affiliation(s)
- Laith H Jamil
- Division of Gastroenterology and Hepatolohgy, Department of Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA,
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Strongin A, Singh H, Eloubeidi MA, Siddiqui AA. Role of endoscopic ultrasonography in the evaluation of extrahepatic cholangiocarcinoma. Endosc Ultrasound 2014; 2:71-6. [PMID: 24949368 PMCID: PMC4062251 DOI: 10.4103/2303-9027.117690] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/28/2013] [Indexed: 01/04/2023] Open
Abstract
Cholangiocarcinoma is a malignancy that arises from biliary epithelium and is associated with a poor prognosis. Accurate preopera-tive diagnosis and staging of cholangiocarcinoma continues to remain difficult. Endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly performed procedure for cholangiocarcinoma and can provide a tissue diagnosis through brush cytology of the bile duct. However, the sensitivity of biliary brush cytology to diagnose cholangiocarcinoma may be as low as 30%. Endoscopic ultrasound (EUS) is a diagnostic modality which may overcome the limitations of other imaging and biopsy techniques in this setting. EUS can complement the role of ERCP and provide a tissue diagnosis through fine needle aspiration (FNA) and staging through ultrasound imaging. There is currently a paucity of data about the exact role of EUS for the diagnosis of cholan-giocarcinoma in patients with indeterminate extrahepatic biliary strictures. Although multiple studies have shown that EUS is more accurate than ERCP and radiologic imaging for identifying a biliary mass and diagnosing cholangiocarcinoma, the sensitivities are variable. More importantly, the incidence of false negative results is not negligible, though the specificity is close to 100%. There is also controversy regarding the role of EUS-FNA, since even though this may increase diagnosis, it can also lead to tumor seeding.
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Affiliation(s)
- Anna Strongin
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Harkirat Singh
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mohamad A Eloubeidi
- Division of Gastroenterology, American University of Beirut, Beirut, Lebanon
| | - Ali A Siddiqui
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Strongin A, Singh H, Eloubeidi MA, Siddiqui AA. Role of endoscopic ultrasonography in the evaluation of extrahepatic cholangiocarcinoma. Endosc Ultrasound 2014. [PMID: 24949368 DOI: 10.7178/eus.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cholangiocarcinoma is a malignancy that arises from biliary epithelium and is associated with a poor prognosis. Accurate preopera-tive diagnosis and staging of cholangiocarcinoma continues to remain difficult. Endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly performed procedure for cholangiocarcinoma and can provide a tissue diagnosis through brush cytology of the bile duct. However, the sensitivity of biliary brush cytology to diagnose cholangiocarcinoma may be as low as 30%. Endoscopic ultrasound (EUS) is a diagnostic modality which may overcome the limitations of other imaging and biopsy techniques in this setting. EUS can complement the role of ERCP and provide a tissue diagnosis through fine needle aspiration (FNA) and staging through ultrasound imaging. There is currently a paucity of data about the exact role of EUS for the diagnosis of cholan-giocarcinoma in patients with indeterminate extrahepatic biliary strictures. Although multiple studies have shown that EUS is more accurate than ERCP and radiologic imaging for identifying a biliary mass and diagnosing cholangiocarcinoma, the sensitivities are variable. More importantly, the incidence of false negative results is not negligible, though the specificity is close to 100%. There is also controversy regarding the role of EUS-FNA, since even though this may increase diagnosis, it can also lead to tumor seeding.
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Affiliation(s)
- Anna Strongin
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Harkirat Singh
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mohamad A Eloubeidi
- Division of Gastroenterology, American University of Beirut, Beirut, Lebanon
| | - Ali A Siddiqui
- Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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24
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Feng XY, Wang W, Luo GY, Wu J, Zhou ZW, Li W, Sun XW, Li YF, Xu DZ, Guan YX, Chen S, Zhan YQ, Zhang XS, Xu GL, Zhang R, Chen YB. Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of gastric cancer - results of a single institution study of 610 Chinese patients. PLoS One 2013; 8:e78846. [PMID: 24223855 PMCID: PMC3815220 DOI: 10.1371/journal.pone.0078846] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study compared the performance of endoscopic ultrasonography (EUS) and multislice spiral computed tomography (MSCT) in the preoperative staging of gastric cancer. METHODOLOGY/PRINCIPAL FINDINGS A total of 610 patients participated in this study, all of whom had undergone surgical resection, had confirmed gastric cancer and were evaluated with EUS and MSCT. Tumor staging was evaluated using the Tumor-Node-Metastasis (TNM) staging and Japanese classification. The results from the imaging modalities were compared with the postoperative histopathological outcomes. The overall accuracies of EUS and MSCT for the T staging category were 76.7% and 78.2% (P=0.537), respectively. Stratified analysis revealed that the accuracy of EUS for T1 and T2 staging was significantly higher than that of MSCT (P<0.001 for both) and that the accuracy of MSCT in T3 and T4 staging was significantly higher than that of EUS (P<0.001 and 0.037, respectively). The overall accuracy of MSCT was 67.2% when using the 13th edition Japanese classification, and this percentage was significantly higher than the accuracy of EUS (49.3%) and MSCT (44.6%) when using the 6th edition UICC classification (P<0.001 for both values). CONCLUSIONS/SIGNIFICANCE Our results demonstrated that the overall accuracies of EUS and MSCT for preoperative staging were not significantly different. We suggest that a combination of EUS and MSCT is required for preoperative evaluation of TNM staging.
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Affiliation(s)
- Xing-yu Feng
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guang-yu Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Endoscopy and Laser, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Wu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Interventional Radiology and Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-wei Zhou
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Li
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-wei Sun
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan-fang Li
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Da-zhi Xu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan-xiang Guan
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shi Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - You-qing Zhan
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-shi Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Melanoma Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China;
| | - Guo-liang Xu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Endoscopy and Laser, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Interventional Radiology and Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ying-bo Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Wee E, Lakhtakia S, Gupta R, Anuradha S, Shetty M, Kalapala R, Monga A, Saravanan A, Rebala P, Ramchandani M, Rao GV, Reddy DN. The diagnostic accuracy and strength of agreement between endoscopic ultrasound and histopathology in the staging of ampullary tumors. Indian J Gastroenterol 2012; 31:324-32. [PMID: 22996048 DOI: 10.1007/s12664-012-0248-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/16/2012] [Indexed: 02/06/2023]
Abstract
AIM Ampullary tumors are rare. Reports on ampullary tumor staging are heterogeneous and combine both periampullary and ampullary tumors. This study assessed the performance of endoscopic ultrasound (EUS) in the local staging of ampullary tumors only. METHODS Data were collected retrospectively. We included patients with an ampullary tumor who underwent EUS and surgical resection. Tumor (T) and nodal (N) TNM staging for EUS and histopathological (HP) staging were compared. RESULTS From 2009 to 2010, a total of 79 patients with ampullary tumors were identified. Of these, 26 had both EUS and Whipple's surgery and were included (28 did not undergo resection, 13 had palliative surgery only and 12 had resection without EUS). For T staging by HP, there were 2 (7.7 %) T1, 11 (42.3 %) T2, 12 (46.2 %) T3 and 1 (3.8 %) T4 tumors. The accuracy of EUS T staging was 73.1 % with a Kappa value of 0.564 (p < 0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) of EUS, respectively were 50.0 %, 91.7 %, 33.3 % and 95.7 % for T1 tumors; 81.8 %, 80.0 %, 75.0 % and 85.7 % for T2; 75.0 %, 92.9 %, 90.0 % and 81.3 % for T3 tumors. For N staging by HP, 17 (65.4 %) were N0 and 9 (34.6 %) N1. The N staging diagnostic accuracy was 80.8 % with a Kappa value of 0.586 (p = 0.003). The sensitivity, specificity, PPV, NPV for N0 disease were 82.4 %, 77.8 %, 87.5 % and 70.0 %, respectively while for N1 they were 77.8 %, 82.4 %, 70.0 % and 87.5 %, respectively. CONCLUSIONS EUS had a moderate strength of agreement with histopathology for both T and N staging, and a high diagnostic accuracy for nodal staging.
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Affiliation(s)
- Eric Wee
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500 082, Andhra Pradesh, India
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Korenblit J, Anantharaman A, Loren DE, Kowalski TE, Siddiqui AA. The role of endoscopic ultrasound-guided fine needle aspiration (eus-fna) for the diagnosis of intra-abdominal lymphadenopathy of unknown origin. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:172-176. [PMID: 23687604 DOI: 10.4161/jig.23742] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/16/2012] [Accepted: 08/28/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The diagnosis of intra-abdominal lymphadenopathy of is difficult, especially when no primary lesion has been identified. We aimed to evaluate the diagnostic yield of EUS-FNA cytology in patients with enlarged intra-abdominal lymph nodes of unknown etiology. PATIENT AND METHODS 147 patients with abdominal lymphadenopathy on imaging in whom EUS-FNA was performed with a 22-gauge needle. Performance characteristics of EUS-FNA including the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were compared between the 2 groups. RESULTS AThe location of the enlarged lymph nodes was the celiac axis (8.2%), peri-gastric (34%), peri-pancreatic (25.2%), peri-portal (27.9%), and other intra-abdominal locations (4.8%). The median number of EUS-FNA passes was 5. The final diagnosis were lymphoma in (n=27), metastatic adenocarcinoma (n=44) patients, other miscellaneous malignancies (n=22) and benign disease (n=54). The sensitivity, specificity, and accuracy of EUS-FNA were 89.7, 98.3, and 93.5% respectively. A false positive FNA result was present in only 1 case (0.7%); false negative FNA results were present in eight cases (5.8%). Lymph node morphologic features of roundness, echogenicity, and homogeneity on EUS were not a predictor of lymph node malignancy. CONCLUSION In a retrospective cohort trial, EUS-FNA was found to be highly accurate and safe in diagnosing patients with intra-abdominal lymphadenopathy of unknown etiology.
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Affiliation(s)
- Jason Korenblit
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA
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27
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Paterson S, Duthie F, Stanley AJ. Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer. World J Gastroenterol 2012; 18:889-95. [PMID: 22408347 PMCID: PMC3297047 DOI: 10.3748/wjg.v18.i9.889] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/16/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess quantitative endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophago-gastric cancers.
METHODS: This was a single tertiary centre study assessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS characteristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.
RESULTS: EUS elastography and FNAB were performed on 53 lymph nodes. Cytological malignancy was found in 23 nodes, one was indeterminate, one was found to be a gastrointestinal stromal tumor and 25 of the nodes were negative for malignancy. On 3 occasions insufficient material was obtained for analysis. The area under the curve for the receiver operating characteristic curve for elastography strain ratio was 0.87 (P < 0.0001). Elastography strain ratio had a sensitivity 83%, specificity 96%, positive predictive value 95%, and negative predictive value 86% for distinguishing between malignant and benign nodes. The overall accuracy of elastography strain ratio was 90%. Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria.
CONCLUSION: EUS elastography is a promising modality that may complement standard EUS and help guide EUS-FNAB during staging of upper gastrointestinal tract cancer.
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Dhir V, Mathew P, Bhandari S, Bapat M, Kwek A, Doctor V, Maydeo A. Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region. J Gastroenterol Hepatol 2011; 26:1721-4. [PMID: 21649725 DOI: 10.1111/j.1440-1746.2011.06800.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Intra-abdominal lymphadenopathy poses a diagnostic and management challenge in highly endemic regions for tuberculosis. Opting for empirical anti-tuberculosis treatment raises the risk of wrong or delayed treatment. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the procedure of choice for tissue acquisition from peri-luminal lymph nodes. We studied the utility of EUS-FNA in evaluating intra-abdominal lymph nodes of unknown etiology, in the setting of high endemicity of tuberculosis. METHODS Consecutive patients with intra-abdominal lymph nodes of unknown etiology underwent EUS-FNA using a 22-gauge needle. Final diagnosis was made on surgical histology or on 6-months follow-up. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic yield were calculated. RESULTS Sixty-six patients were included. Final diagnoses were tuberculosis, 35 (53%); metastatic adenocarcinoma, 11 (16.7%); lymphoma, three (4.5%); carcinoid, one (1.5%) and reactive nodes, 16 (24.2%). EUS-FNA provided a diagnosis in 61 patients (92.4%). Sensitivity, specificity, PPV and NPV for diagnosing tuberculosis via EUS-FNA were 97.1%, 100%, 100% and 96.9%, respectively. In 10 (15.2%) patients receiving empirical anti-tuberculosis treatment, the final diagnoses were metastatic adenocarcinoma (5), lymphoma (2), carcinoid (1) and reactive adenopathy (2). CONCLUSION Despite being in a highly endemic area, almost half of the patients studied have a non-tuberculosis etiology. EUS-FNA is a safe and accurate procedure for establishing the diagnosis of unexplained intra-abdominal lymphadenopathy.
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Affiliation(s)
- Vinay Dhir
- Department of Endoscopy and Endosonography, Mumbai, India Department of Pathology, Institute of Advanced Endoscopy, Mumbai, India.
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de Melo SW, Panjala C, Crespo S, Diehl NN, Woodward TA, Raimondo M, Wallace MB. Interobserver agreement on the endosonographic features of lymph nodes in aerodigestive malignancies. Dig Dis Sci 2011; 56:3204-8. [PMID: 21573731 DOI: 10.1007/s10620-011-1725-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 04/15/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is used to locally stage aerodigestive malignancies. Endosonographic features are used to predict malignant lymph nodes (MLN). Interobserver agreement on the endosonographic features of MLN has not been described. AIMS To evaluate the interobserver agreement among endosonographers on the EUS features of MLN in aerodigestive malignancies along with the specific feature used to make this distinction. METHODS A total of 760 procedures of suspected LN were reviewed. Cases were selected based on cytology-proven malignant or benign LN involvement by FNA with correspondent photodocumentation. Images of each LN were de-identified and distributed to three expert endosonographers. The experts recorded the LN's echogenicity (hypoechoic or other), shape (round or other), border (sharp or fuzzy) and subjective diagnosis (benign or malignant). The relationship between the endosonographers' subjective as well as the pathological diagnosis and LN's endosonographic features were analyzed using logistic regression analysis. Pair-wise comparison between endoscopist and interobserver agreement (kappa statistics) were performed. RESULTS Images of 41 malignant and 35 benign LN were evaluated. There was fair agreement on shape, Κ = 0.35 (95% CI 0.2-0.5), and moderate agreement on echogenicity and borders, Κ = 0.46 (95% CI 0.31-0.61) and 0.43 (95% CI 0.27-0.58) respectively. The agreement on malignant LN was good, Κ = 0.65 (95% CI 0.5-0.8). The overall diagnostic predictive accuracy ranged from 70 to 77% among the three endoscopists.Two of the three endoscopists assessed shape as the most predictive feature of malignancy (OR 39.4, 95% CI 3.29-470.96). CONCLUSION The inter-observer agreement on the individual lymph node features as obtained by EUS is moderate with good overall agreement on the diagnosis. Round shape was the feature most strongly associated with a diagnosis of MLN.
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Affiliation(s)
- Silvio W de Melo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
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De Swarte M, Alexander K, Rannou B, D'Anjou MA, Blond L, Beauchamp G. Comparison of sonographic features of benign and neoplastic deep lymph nodes in dogs. Vet Radiol Ultrasound 2011; 52:451-6. [PMID: 21382121 DOI: 10.1111/j.1740-8261.2011.01808.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The differentiation of benign vs. neoplastic lymph nodes impacts patient management. Specific sonographic features are typically considered when assessing lymph nodes in dogs. However, the usefulness of these criteria in distinguishing benign vs. malignant lymph nodes remains largely unknown, especially for deep lymph nodes. Our aim was to compare sonographic features in benign and neoplastic deep lymph nodes with the hope of identifying predictive criteria. Thirty-one deep lymph nodes (16 mesenteric, 10 medial iliac, three hepatic, one sternal, and one cranial mediastinal) in 31 dogs were examined prospectively with B-mode and Color flow Doppler. Lymph nodes were aspirated using ultrasound-guidance and final diagnosis were established based on cytologic and/or histopathologic interpretation. Prevalence of each sonographic feature and combinations of two features was calculated for each group and compared using a χ(2) -test or Student's t-test for unequal variances. Ten lymph nodes were benign (hyperplastic and/or inflammatory) and 21 were neoplastic. All were hypoechoic, except for one neoplastic lymph node. Maximal short-axis diameter (P=0.0006) and long-axis diameter (P=0.01), and SA/LA ratio (P=0.008) were increased significantly for neoplastic (2.8, 5.5 cm, and 0.50, respectively) vs. benign (1.2, 3.8 cm, and 0.34, respectively) lymph nodes. The prevalence of other features was similar between groups. Doppler evaluation was possible in 77% of lymph nodes, but there was no significant difference between groups. When any two ultrasound features were combined, the only difference between benign and neoplastic lymph nodes was for the combination of contour regularity and appearance of the perinodal fat (P=0.03).
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Affiliation(s)
- Marie De Swarte
- Départements de Sciences, Cliniques et de Biomédecine, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada J2S 7C6
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31
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Gill KRS, Ghabril MS, Jamil LH, McNeil RB, Woodward TA, Raimondo M, Hoffman BJ, Hawes RH, Romagnuolo J, Wallace MB. Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. Gastrointest Endosc 2010; 72:265-71. [PMID: 20541192 PMCID: PMC2925200 DOI: 10.1016/j.gie.2010.02.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 02/18/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear. OBJECTIVE To evaluate the utility of EUS-determined LN features for predicting malignant cytology. DESIGN Prospective observational study. SETTING Two U.S. tertiary-care centers. PATIENTS This study involved 425 patients with primary lung cancer who underwent EUS. INTERVENTION All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established. MAIN OUTCOME MEASUREMENTS Accuracy of individual LN features for predicting malignancy. RESULTS EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4% (95% confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63% (95% CI, 51%-72.2%) when all features were seen. LIMITATIONS No surgical histology as the criterion standard. CONCLUSION Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.
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Affiliation(s)
| | - Marwan S. Ghabril
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Laith H. Jamil
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | | | - Timothy A. Woodward
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Massimo Raimondo
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Brenda J. Hoffman
- Department of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina
| | - Robert H. Hawes
- Department of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Romagnuolo
- Department of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina
| | - Michael B. Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Zhong L, Liao JZ, Wang Y, Cheng B. Diagnostic value of endoscopic ultrasonography in preoperative TN staging of esophageal carcinoma. Shijie Huaren Xiaohua Zazhi 2010; 18:2258-2261. [DOI: 10.11569/wcjd.v18.i21.2258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative TN staging of esophageal carcinoma.
METHODS: Thirty patients with esophageal carcinoma were subjected to preoperative TN staging by EUS and postoperative pathological staging. The results for preoperative and postoperative TN staging were then compared.
RESULTS: The accuracy of T and N staging by EUS was 76.7% (23/30) and 83.3% (25/30), respectively. The coincidence rate between preoperative T staging by EUS and postoperative pathological staging of early esophageal carcinoma was up to
100%.
CONCLUSION: EUS has a high accuracy in preoperative TN staging of esophageal carcinoma, especially early esophageal carcinoma, and may therefore be used to guide clinical treatment of the disease.
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Jost C, Binek J, Schuller JC, Bauerfeind P, Metzger U, Werth B, Knuchel J, Frossard JL, Bertschinger P, Brauchli P, Meyenberger C, Ruhstaller T. Endosonographic radial tumor thickness after neoadjuvant chemoradiation therapy to predict response and survival in patients with locally advanced esophageal cancer: a prospective multicenter phase ll study by the Swiss Group for Clinical Cancer Research (SAKK 75/02). Gastrointest Endosc 2010; 71:1114-21. [PMID: 20304399 DOI: 10.1016/j.gie.2009.12.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 12/03/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS response assessment in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiation therapy (CRT) is limited by disintegration of the involved anatomic structures. OBJECTIVE Predictive and prognostic values of a prospectively defined maximum tumor thickness (MTT). DESIGN Prospective open-label phase ll study (SAKK 75/02). SETTING Multicenter, nationwide. PATIENTS Of 66 patients with primary CRT, 56 underwent en bloc esophagectomy. INTERVENTIONS EUS-measured MTT before and 2-5 weeks after CRT (yMTT). MAIN OUTCOME MEASUREMENTS Cutoffs: (1) absolute thickness (yMTT) after CRT < or = 6 mm; (2) relative reduction compared with baseline (ratio yMTT/MTT) < or = 50%. Correlation between EUS measurements and histopathologic tumor regression grade (TRG) and overall survival (OS). RESULTS Sixteen of 56 patients were not included for EUS evaluation (10 severe stenosis, 5 MTT not measured, 1 intolerance to second EUS). Characteristics (n = 40) were as follow: median age, 60 years; squamous cell carcinoma, 42%; and adenocarcinoma (AC), 58%. Initial stage was: 10 T2N1, 3 T3N0, 26 T3N1, 1 T3Nx; 14 of 23 AC Siewert type 1. Wilcoxon rank sum test showed significant correlation of TRG1 with yMTT < or = 6 mm (P = .008) and yMTT/MTT < or = 50% (P = .003). The effect of yMTT on TRG1 was significant (P = .0193; odds ratio, 0.687 [95% CI, 0.502-0.941]). The predefined cutoff of < or = 6 mm for yMTT was predictive for TRG1 (P = .0037; Fisher exact test). After a median follow-up of 28.6 months, there was a clear trend for benefit in OS with yMTT < or = 6 mm and yMTT/MTT < or = 50%. LIMITATIONS Small sample size. CONCLUSION In a multicenter setting, MTT measured by EUS after CRT was highly predictive for response and showed a clear trend for predicting survival.
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Affiliation(s)
- Christian Jost
- Department of Gastroenterology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Al-Haddad M, Savabi MS, Sherman S, McHenry L, Leblanc J, Cramer H, Emerson R, O'Neil J, Khashab M, Dewitt J. Role of endoscopic ultrasound-guided fine-needle aspiration with flow cytometry to diagnose lymphoma: a single center experience. J Gastroenterol Hepatol 2009; 24:1826-33. [PMID: 19845824 DOI: 10.1111/j.1440-1746.2009.06005.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) +/- flow cytometry (FC) for the diagnosis of suspected lymphoma remains controversial. We report our experience and diagnostic yield for EUS +/- FC for suspected lymphoma. METHODS Databases were queried for those who underwent EUS-FNA +/- FC for suspected lymphoma. Hospital charts were reviewed to confirm the final cytological diagnosis, follow up and FC results if obtained. The final diagnosis was confirmed by the results of EUS-FNA +/- FC, other biopsy and/or follow up. RESULTS In total, 54 patients underwent EUS-FNA of 72 lesions. The final diagnosis of lymphoma was made in 38 of the 54 (70%) patients, and 33 of the 54 (61%) patients relied on EUS-FNA. Cytopathology in 41 patients using EUS-FNA + FC showed lymphoma in 24 patients, atypical lymphoid cells in six and reactive lymph node in 11. In 9 of the 24 with lymphoma by EUS + FC, the diagnosis was confirmed by another diagnostic modality, like surgery, bone marrow biopsy and computed tomography-guided biopsy. Of the six with atypical lymphoid cells, additional diagnostic methods confirmed lymphoma in three. The remaining 13 of the 54 patients underwent EUS-FNA without FC due to insufficient sample (n = 5) or operator choice (n = 8). Cytopathology in these 13 patients without FC showed lymphoma (9), atypical lymphoid cells (3) and reactive node (1). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA for lymphoma in all 54 patients ranged from 80% to 87%, 92% to 93%, 97%, 60% to 75% and 83% to 89%, respectively. CONCLUSIONS EUS-FNA is sensitive and specific for the diagnosis of suspected lymphoma. Confirmatory or further testing should be performed when EUS-FNA with or without FC is indeterminate and or non-diagnostic.
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Affiliation(s)
- Mohammad Al-Haddad
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Gleeson FC, Clain JE, Papachristou GI, Rajan E, Topazian MD, Wang KK, Levy MJ. Prospective assessment of EUS criteria for lymphadenopathy associated with rectal cancer. Gastrointest Endosc 2009; 69:896-903. [PMID: 18718586 DOI: 10.1016/j.gie.2008.04.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/21/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are few data that assess the accuracy of echo characteristics for predicting lymph-node (LN) metastases in patients with rectal cancer. OBJECTIVE To identify nodal echo characteristics and size predictive of malignant infiltration and to determine if any combination of standard nodal criteria has sufficient predictive value to preclude FNA. DESIGN Prospective uncontrolled study. SETTING Tertiary-referral hospital. PATIENTS Seventy-six patients (68% men) with untreated rectal cancer; 52 had visualized LNs. INTERVENTION EUS-guided FNA. MAIN OUTCOME MEASUREMENTS Evaluation of perirectal nodal morphology accuracy that corresponds to malignant cytology and identification of echo criteria, including LN size, to have sufficient predictive value to predict malignancy. RESULTS Forty-three of 52 patients (83%) underwent FNA of a visualized LN. Nodal hypoechogenicity and short-axis length >or=5 mm were factors independently predictive of malignancy. The number of malignant nodal echo features per node did not distinguish benign from malignant pathology, except when all 4 features were present. Only 68% of malignant LN had >or=3 echo characteristics. An optimum LN short-axis or long-axis length cutoff value of 6 mm or 9 mm were 90% and 95% specific, respectively, for the presence of malignancy by receiver operating characteristic analysis. LIMITATIONS FNA was performed in a subset of identified LNs. CONCLUSIONS Nodal echo features alone are often inadequate to establish the presence of locoregional metastatic disease by EUS. These data support the value of FNA to confirm the presence of malignancy in place of relying on imaging criteria.
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Affiliation(s)
- Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, Kim WH, Lee KU, Yang HK. Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol 2009; 99:20-7. [PMID: 18937292 DOI: 10.1002/jso.21170] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preoperative accurate diagnosis of the T and N stages in early gastric cancer (EGC) is important in determining the application of various limited treatments. The aim of this study is to analyze the accuracy of T and N staging of EGC with esophagogastroduodenoscopy (EGD), Stomach protocol CT (S-CT), and endoscopic ultrasonography (EUS), and the factors influencing the accuracy. METHODS Four hundred and thirty-four patients preoperatively diagnosed as EGC using EGD or S-CT and undergoing curative gastrectomy at Seoul National University Hospital in 2005 were included. The T and N stage reviewed by experienced personnel were compared with the surgical pathology. RESULTS The predictive values for EGC of EGD, S-CT, and EUS were 87.4%, 92.2%, and 94.1%, respectively. The predictive values for node negativity of S-CT, and EUS were 90.1% and 92.6%, respectively. The factors leading to underestimation of T stage with EGD were the upper third location, the size greater than 2 cm, and diffuse type of tumor. Those with S-CT were female sex, the upper third location and lesion size greater than 2 cm. CONCLUSIONS Before applying limited treatment for EGC, a surgeon should consider the risk factors of underestimation of T stage with EGD or S-CT.
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Affiliation(s)
- Hye Seong Ahn
- Department of Surgery, Seoul National University College of Medicine, Jongno-Gu, Seoul, Korea
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Hall JD, Kahaleh M, White GE, Talreja J, Northup PG, Shami VM. Presence of lymph node vasculature: a new EUS criterion for benign nodes? Dig Dis Sci 2009; 54:118-21. [PMID: 18473175 DOI: 10.1007/s10620-008-0314-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Accepted: 04/24/2008] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Lymph nodes normally have prominent centrally located blood vessels, which may become obliterated with tumor infiltration. The presence of intranodal vasculature has been noted to coincide with benign cytology. We sought to determine the test characteristics of the presence of intranodal mediastinal vasculature during endoscopic ultrasound (EUS). METHODS 67 mediastinal lymph nodes evaluated by EUS in 66 patients over a 1-year period were evaluated for the presence of intranodal vasculature, which was considered benign when it traversed through the node without disruption. RESULTS Of the 67 lymph nodes evaluated, 29 (43%) were found to be malignant on cytopathologic review. Benign vascular markings were present in 15/67 (22.4%) lymph nodes evaluated. All 15 (100%) of these nodes were found to have benign fine-needle aspiration (FNA) results. The presence of benign vasculature had a negative predictive value of 100%. CONCLUSIONS The presence of intranodal vasculature was universally associated with a benign diagnosis. The addition of this EUS finding improves the ability to characterize lymph nodes and predict the likelihood of malignant involvement.
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Affiliation(s)
- Joshua D Hall
- Digestive Health Center of Excellence, University of Virginia Health System, Box 800708, Charlottesville, VA 22908-0708, USA
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Kalaitzakis E, Sadik R, Doig L, Meenan J. Defining the lymph node burden in a Northern European population without malignancy: the potential effect of geography in determining a need for FNA? Dis Esophagus 2008; 22:409-17. [PMID: 19207548 DOI: 10.1111/j.1442-2050.2008.00900.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Data from the USA suggest that morphological specificity is insufficient to permit an assumption of malignancy in nodal staging with endoscopic ultrasound (EUS). This may not hold true elsewhere as the background lymph node burden may vary in different geographic regions. We aimed to assess the prevalence and features of mediastinal and abdominal lymph nodes at EUS in a Northern European population without malignant disease. A total of 129 consecutive patients without malignant disease referred for radial EUS were prospectively evaluated for the prevalence and echo features of lymph nodes in the mediastinum and upper abdomen. Sixty-two percent of patients had mediastinal lymph nodes and 17% had abdominal nodes at EUS. A mean of 1.4 (standard deviation 1.3, range 0-8) nodes were found per patient. No celiac nodes were seen. The majority of detected nodes were 0.5 cm or less in short axis, had oval shape, centrally echogenic pattern, and indistinct borders. The most common node locations were the subcarinal and paraesophageal areas, and the hepatoduodenal ligament. In multivariate analysis mediastinal lymphadenopathy was related to body mass index and abdominal lymphadenopathy to acute pancreatitis. The occurence of mediastinal lymphadenopathy is markedly lower in Northern Europeans than reported for US patients. Celiac nodes are extremely rare in patients without malignancy. The majority of nodes have a width of 0.5 cm or less, have oval shape, centrally echogenic pattern, and indistinct borders. The characterization of the background lymph node burden may improve the selection of lymph nodes for fine needle aspiration.
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Affiliation(s)
- E Kalaitzakis
- Department of Gastroenterology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc 2008; 67:438-43. [PMID: 18061597 DOI: 10.1016/j.gie.2007.07.018] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 07/09/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined. OBJECTIVES To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation. DESIGN Retrospective case series. SETTING Tertiary referral EUS unit. PATIENTS Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated. INTERVENTIONS EUS-FNA. MAIN OUTCOME MEASUREMENTS Lymph-node morphology and echo features. RESULTS EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17%), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy. LIMITATIONS Single institution, retrospective analysis. CONCLUSIONS EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17% of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.
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Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD, Davila RE, Dominitz JA, Harrison ME, Ikenberry SO, Lichtenstein D, Qureshi W, Shen B, Zuckerman M, Fanelli RD, Lee KK, Van Guilder T. Role of EUS. Gastrointest Endosc 2007; 66:425-34. [PMID: 17643438 DOI: 10.1016/j.gie.2007.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Song HJ, Kim JO, Eun SH, Cho YD, Jung IS, Cheon YK, Moon JH, Lee JS, Lee MS, Shim CS, Kim BS, Jin SY. Endoscopic Ultrasonograpic Findings of Benign Mediastinal and Abdominal Lymphadenopathy Confirmed by EUS-guided Fine Needle Aspiration. Gut Liver 2007; 1:68-73. [PMID: 20485661 DOI: 10.5009/gnl.2007.1.1.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 04/27/2007] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS Distinguishing benign and malignant lymph nodes by the findings of endoscopic ultrasonography (EUS) is still controversial. We tried to evaluate EUS findings of benign mediastinal and abdominal lymphadenopathy (BLAP) confirmed by EUS-guided fine needle aspiration (FNA). METHODS A total of 37 patients with enlarged mediastinal or abdominal lymph nodes (diameter >/=1 cm) were enrolled and EUS-FNA was performed. Final diagnosis was based on FNA cytology and follow up imaging studies (CT scans or EUS). RESULTS Thirteen patients were confirmed to have BLAP by EUS-FNA. Causes of BLAP were as follows; (i) extrapulmonary tuberculosis in six cases including patients with postoperative states due to cervical cancer and advanced gastric cancer, (ii) Kikuchi disease in one case, (iii) hypereosinophilic syndrome in one case, (iv) reactive hyperplasia in five cases including patients with postoperative states due to thyroid cancer, lung cancer, and EGC with ESD. EUS findings of BLAP revealed that median lymph node size was 24.7 mm. Lymph nodes were oval or round shaped in 9 cases, sharp borders in 9 cases, hypoechoic echo pattern in 7 cases, heterogenous internal echo pattern in 7 cases. Other findings included internal septation, calcification, multiplicity, attachment to the gastrointestinal tract wall, and conglomeration. CONCLUSIONS EUS findings of BLAP were not different from those of malignant lymphadenopathy previously reported in other studies.
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Affiliation(s)
- Hae Jung Song
- Institute for Digestive Research, Digestive Disease Center, SoonChunHyang University College of Medicine, Seoul, Korea
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Jacobson BC, Chak A, Hoffman B, Baron TH, Cohen J, Deal SE, Mergener K, Petersen BT, Petrini JL, Safdi MA, Faigel DO, Pike IM. Quality indicators for endoscopic ultrasonography. Gastrointest Endosc 2006; 63:S35-8. [PMID: 16564910 DOI: 10.1016/j.gie.2006.02.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Brian C Jacobson
- ASGE Communications Department, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523, USA.
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Jacobson BC, Chak A, Hoffman B, Baron TH, Cohen J, Deal SE, Mergener K, Petersen BT, Petrini JL, Safdi MA, Faigel DO, Pike IM. Quality indicators for endoscopic ultrasonography. Am J Gastroenterol 2006; 101:898-901. [PMID: 16635234 DOI: 10.1111/j.1572-0241.2006.00674.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kanamori A, Hirooka Y, Itoh A, Hashimoto S, Kawashima H, Hara K, Uchida H, Goto J, Ohmiya N, Niwa Y, Goto H. Usefulness of contrast-enhanced endoscopic ultrasonography in the differentiation between malignant and benign lymphadenopathy. Am J Gastroenterol 2006; 101:45-51. [PMID: 16405532 DOI: 10.1111/j.1572-0241.2006.00394.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Endoscopic ultrasonography (EUS) is considered the most useful diagnostic modality for regional staging; however, it is still difficult to diagnose lymph node metastasis by EUS images only. In this study, we report the usefulness of contrast-enhanced EUS (CE-EUS) in the evaluation of benign lymph nodes (BLN) or malignant lymph nodes (MLN) based on blood flow patterns. SUBJECTS AND METHODS In the retrospective study, CE-EUS was performed in 46 patients in whom EUS revealed lymph node in the mediastinum or abdominal cavity. The subjects consisted of 22 patients with BLN and 24 patients with MLN. The lesions were examined by EUS, and the maximal and minimal diameters of lymph nodes were measured. Thereafter, the shape and internal echoes were investigated, and the findings were morphologically classified based on Catalano's report. Enhancement effects and the diagnostic capability of CE-EUS were evaluated. In the prospective study, BLNs were differentiated from MLN using the enhancement patterns on CE-EUS based on the results of the retrospective study, and the diagnostic capability was evaluated. RESULTS In the retrospective study, there were no significant differences in the maximal diameter and maximal/minimal diameter ratio between MLN and BLN. The morphology was classified into four types. Based on the morphological classification, the sensitivity, specificity, and accuracy rate were 88.2%, 77.3%, and 82.1%, respectively. On CE-EUS, the enhancement pattern was classified into three types. The BLN lesions showed uniform enhancement (19/22). In all patients with MLN, a defect of enhancement was observed (24/24). The sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 86.4%, and 92.3%, respectively. In the prospective study, the sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 81.8%, and 92.0%, respectively. CONCLUSIONS CE-EUS is useful for differentiating BLN from MLN.
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Affiliation(s)
- Akira Kanamori
- Department of Gastroenterology, Nagoya University School of Medicine, Nagoya, Japan
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:2722-2726. [DOI: 10.11569/wcjd.v12.i11.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Vander Noot MR, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, Syed S, Chhieng DC. Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2004; 102:157-63. [PMID: 15211474 DOI: 10.1002/cncr.20360] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) allows detailed imaging of both intramural and extramural structures of the gastrointestinal (GI) tract and also allows tissue samples to be obtained from masses and lesions in the GI tract. The objective of the current study was to determine the diagnostic utility of EUS-FNA in evaluating intramural and extramural GI tract lesions. METHODS The authors evaluated all EUS-FNA specimens of GI tract lesions obtained over a 30-month period (from August 2000 to February 2003). Samples of pancreatic and intrabdominal/mediastinal lymph nodes were excluded from the study. A single endosonographer performed all procedures. An attending cytopathologist also was present on site to assess specimen adequacy. Cytologic diagnoses were analyzed for correlations with final diagnoses, which were based on histologic examination of biopsied/resected pathology materials and/or clinical follow-up findings. RESULTS Sixty-two EUS-FNA specimens of intramural and extramural GI tract lesions were obtained from a total of 60 patients. The mean patient age was 58.8 years (standard deviation, 15.3 years). Thirty-six patients (60%) were male, and 24 (40%) were female. Twenty-eight patients had surgical pathologic evaluation of the corresponding lesions. The remaining 32 patients were followed clinically for a mean duration of 9.5 months (standard deviation, 7.7 months). The anatomic sites of the lesions were as follows: esophagus in 23 patients (37%), stomach in 13 patients (21%), duodenum in 15 patients (24%), and rectum/sigmoid in 11 patients (18%). It is noteworthy that 29 patients (43%) previously had experienced unsuccessful attempts at tissue diagnosis by endoscopic forceps biopsy. Of the 62 EUS-FNA specimens, 43, 4, and 15 were reported as being positive for a neoplasm, suspicious, and benign, respectively. Neoplastic lesions included carcinoma (n = 24), gastrointestinal stromal tumor (GIST; n = 18), neuroendocrine neoplasm (n = 2), and lymphoma (n = 1). There were two cases of endometriosis, three foregut duplication cysts, and one case of diverticulosis. There were two lesions that yielded false-negative findings (one gastric lymphoma and one GIST) secondary to sampling or interpretive error. There also were three cases that yielded false-positive findings (one case of endometriosis, one case of duodenal diverticula with smooth muscle hyperplasia, and one case of normal pancreas, which presented as a periduodenal mass). The sensitivity, specificity, and diagnostic accuracy of EUS-FNA in diagnosing GI tract neoplastic lesions were 89%, 88%, and 89%, respectively. CONCLUSIONS EUS-FNA provides accurate tissue diagnosis in a wide variety of extraintestinal mass lesions and intramural GI tumors, particularly in patients for whom previous endoscopic forceps biopsy was unsuccessful in establishing a diagnosis.
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Affiliation(s)
- Martin R Vander Noot
- Department of Pathology, University of Alabama-Birmingham, Birmingham, Alabama, USA
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Shimoyama S, Yasuda H, Hashimoto M, Tatsutomi Y, Aoki F, Mafune KI, Kaminishi M. Accuracy of linear-array EUS for preoperative staging of gastric cardia cancer. Gastrointest Endosc 2004; 60:50-5. [PMID: 15229425 DOI: 10.1016/s0016-5107(04)01312-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The feasibility of a less invasive operation for early stage cancer of the gastric cardia with a low frequency of lymph node involvement has been previously demonstrated by us. Precise discrimination among mucosal, submucosal, and advanced cancers, as well as accurate evaluation of the proximal tumor margin are prerequisites for such stage-specific treatment. EUS is considered the most reliable staging modality. However, there is no EUS study specifically of cardia cancer. METHODS Forty-five patients with gastric cardia cancer who underwent gastrectomy with at least first-tier lymphadenectomy were retrospectively analyzed. The results of preoperative linear-array echoendoscopy (7.5 MHz) with respect to cancer depth, lymph node involvement, and esophageal invasion were compared with postoperative histopathologic findings. RESULTS Overall diagnostic accuracy for depth of invasion was 71%. Sensitivity for T1, T2, and T3 lesions was 100%, 31% and 75%, respectively. Overstaging of T2 cancers was the main diagnostic error. Mucosal (pT1-m) and submucosal (pT1-sm) cancers were correctly discriminated in 81% of patients. Diagnostic accuracy for lymph node involvement was 80%. EUS had positive and negative predictive values of 90% and 80%, respectively, for esophageal invasion. CONCLUSIONS For gastric cardia cancer, the linear-array echoendoscope yielded satisfactory results with respect to depth of invasion, lymph node involvement, and esophageal invasion evaluation. The information obtained is useful to the performance of stage-specific treatment.
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Affiliation(s)
- Shouji Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, Japan
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Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol 2004; 99:628-33. [PMID: 15089893 DOI: 10.1111/j.1572-0241.2004.04064.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE The additional diagnostic value of endoscopic ultrasound-fine needle aspiration (EUS-FNA) over lymph node (LN) echofeatures alone in evaluating lymphadenopathy is unknown. The objectives of this study are (1) to prospectively evaluate the utility of EUS-FNA in evaluating mediastinal or peri-intestinal lymphadenopathy and to compare its yield to that of echofeatures alone and (2) to determine clinical and endosonographic features predictive of malignant involvement of LNs. METHODS All consecutive patients who underwent EUS-FNA of a LN over a 22-month period were prospectively evaluated. Reference standard for final diagnosis included: surgery (n = 76), long-term clinical and/or imaging follow-up (n = 74), or death from disease (n = 26). RESULTS One hundred and eighty-three EUS-FNAs of LNs were performed in 137 patients with no major complications. Locations of the biopsied LNs included 31% subcarinal, 21% celiac, 21% peripancreatic, 13% periesophageal, 4.4% aortopulmonary window, 3.2% perigastric, and 3.3% perirectal. Mean LN size was 20.5 mm (SD +/- 11.1) x 13.2 mm (SD +/- 7.97). The mean number of EUS-FNA passes was three (range 1-7). The sensitivity, specificity, PPV, and NPV of EUS-FNA of LNs were 98.3%, 100%, 100%, and 98.4%, respectively. EUS-FNA was more accurate compared to LN echofeatures alone (99.4%vs 75.4%, p < 0.001). Mediastinal LNs were 2.77 times less likely to be malignant as compared to other LN locations. In multivariable analysis, the number of LN echofeatures, site of LN, and patient's age were associated with malignant involvement (p= 0.001). CONCLUSIONS EUS-FNA is superior to LN echofeatures in evaluating lymphadenopathy. Endosonographic LN features alone are particularly unreliable in the mediastinum, necessitating tissue confirmation. EUS-FNA can safely, reliably, and accurately sample mediastinal and peri-intestinal LNs obviating the need for more invasive testing or surgical intervention.
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Affiliation(s)
- Victor K Chen
- Department of Medicine, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA
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