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Ultrasound, computed tomography, or the combination for the detection of supraclavicular lymph nodes in patients with esophageal or gastric cardia cancer: a comparative study
Author(s) -
van Vliet Evelyn P.M.,
Lugt Aad van der,
Kuipers Ernst J.,
Tilanus Hugo W.,
Gaast Ate van der,
Hermans John J.,
Siersema Peter D.
Publication year - 2007
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20819
Subject(s) - medicine , radiology , supraclavicular lymph nodes , lymph , esophageal cancer , fine needle aspiration , lymph node , endoscopic ultrasound , prospective cohort study , cancer , esophagus , biopsy , metastasis , surgery , pathology
Background and Objectives Both ultrasound (US) and computed tomography (CT) can be used to detect supraclavicular lymph node metastases. Aim was to compare US, US plus fine‐needle aspiration (US‐FNA), CT, US + CT, and US‐FNA + CT for the detection of these metastases in esophageal or gastric cardia cancer patients. Methods Between 1994 and 2004, 567 patients underwent US and CT for esophageal or gastric cardia cancer staging. Gold standard was postoperative detection of lymph nodes in the resected specimen, FNA, or a radiological result with follow‐up. Results Sensitivities of US (75%), US‐FNA (72%), US + CT (80%), and US‐FNA + CT (79%) were higher than sensitivity of CT alone (25%) ( P < 0.001). Specificities were high for US‐FNA (100%), CT (99%), and US‐FNA + CT (99%), whereas those of US alone (91%) and US + CT (91%) were lower ( P < 0.001). In 4/65 (6%) patients with true‐positive malignant lymph nodes, CT was positive with US and/or US‐FNA being negative. However, in 36/65 (55%) patients, US and/or US‐FNA were positive with CT being negative. Conclusion US‐FNA seems the preferred diagnostic modality for the detection of supraclavicular lymph node metastases in patients with esophageal or gastric cardia cancer. Sensitivity of metastases detection only slightly improves if US‐FNA is combined with CT. A prospective, comparative study is however needed. J. Surg. Oncol. 2007;96: 200–206. © 2007 Wiley‐Liss, Inc.