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Annals of Surgery logoLink to Annals of Surgery
. 1999 Jan;229(1):62–66. doi: 10.1097/00000658-199901000-00008

Assessment of cervical lymph node metastasis in esophageal carcinoma using ultrasonography.

S Natsugoe 1, H Yoshinaka 1, M Shimada 1, K Shirao 1, S Nakano 1, C Kusano 1, M Baba 1, T Fukumoto 1, S Takao 1, T Aikou 1
PMCID: PMC1191609  PMID: 9923801

Abstract

OBJECTIVE: To evaluate the efficacy of ultrasonography for the diagnosis of cervical lymph node metastasis in esophageal carcinoma. SUMMARY BACKGROUND DATA: Ultrasound (US) examination is useful for diagnosing lymph node metastasis. However, few reports have examined its role in the decision to perform cervical lymph node dissection in esophageal carcinoma. METHODS: Ultrasound examination was performed to evaluate cervical lymph node metastasis in 519 patients with esophageal carcinoma. The patients were divided into 5 groups according to treatment received: group 1, 153 patients who underwent curative resection of primary tumor by right thoracotomy and complete bilateral cervical lymphadenectomy; group 2, 112 patients who underwent curative resection of primary tumor by right thoracotomy but without cervical lymphadenectomy; group 3, 78 patients who underwent esophagectomy by left thoracotomy or blunt dissection with or without removal of cervical lymph nodes; group 4, 76 patients with palliative resection without cervical lymphadenectomy; and group 5, 100 patients without any surgical treatment. US diagnosis was compared with histologic findings or cervical lymph node recurrence. RESULTS: Lymph node metastasis was detected in 30.8% of patients (160/519). The sensitivity, specificity, and accuracy of US diagnosis in group 1 were 74.5%, 94.1%, and 87.6%, respectively. Cervical lymph node recurrence was seen in 7 patients (4.6%) in group 1, in 4 patients (3.6%) in group 2, and 3 patients (3.8%) in group 3. Although the incidence of cervical lymph node metastasis as determined by US examination was high in groups 4 and 5, almost none of the patients died of cervical lymph node metastasis. CONCLUSIONS: Ultrasound examination plays a useful role in the decision to perform cervical lymph node dissection in patients with esophageal carcinoma, particularly in those with potentially curative dissection.

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  1. Baba M., Aikou T., Yoshinaka H., Natsugoe S., Fukumoto T., Shimazu H., Akazawa K. Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg. 1994 Mar;219(3):310–316. doi: 10.1097/00000658-199403000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Botet J. F., Lightdale C. J., Zauber A. G., Gerdes H., Winawer S. J., Urmacher C., Brennan M. F. Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT. Radiology. 1991 Nov;181(2):426–432. doi: 10.1148/radiology.181.2.1924784. [DOI] [PubMed] [Google Scholar]
  3. Dittler H. J., Siewert J. R. Role of endoscopic ultrasonography in esophageal carcinoma. Endoscopy. 1993 Feb;25(2):156–161. doi: 10.1055/s-2007-1010275. [DOI] [PubMed] [Google Scholar]
  4. Freimanis A. K. Echographic diagnosis of lesions of the abdominal, aorta and lymph nodes. Radiol Clin North Am. 1975 Dec;13(3):557–572. [PubMed] [Google Scholar]
  5. Gordon P. B., Gilks B. Sonographic appearance of normal intramammary lymph nodes. J Ultrasound Med. 1988 Oct;7(10):545–548. doi: 10.7863/jum.1988.7.10.545. [DOI] [PubMed] [Google Scholar]
  6. Greenberg J., Durkin M., Van Drunen M., Aranha G. V. Computed tomography or endoscopic ultrasonography in preoperative staging of gastric and esophageal tumors. Surgery. 1994 Oct;116(4):696–702. [PubMed] [Google Scholar]
  7. Hiele M., De Leyn P., Schurmans P., Lerut A., Huys S., Geboes K., Gevers A. M., Rutgeerts P. Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction. Gastrointest Endosc. 1997 May;45(5):381–386. doi: 10.1016/s0016-5107(97)70148-2. [DOI] [PubMed] [Google Scholar]
  8. Kato H., Tachimori Y., Mizobuchi S., Igaki H., Ochiai A. Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus. Cancer. 1993 Nov 15;72(10):2879–2882. doi: 10.1002/1097-0142(19931115)72:10<2879::aid-cncr2820721004>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  9. Natsugoe S., Aikou T., Yoshinaka H., Saihara T., Baba M., Takao S., Fukumoto T. Lymph node metastasis of early stage carcinoma of the esophagus and of the stomach. J Clin Gastroenterol. 1995 Jun;20(4):325–328. doi: 10.1097/00004836-199506000-00015. [DOI] [PubMed] [Google Scholar]
  10. Natsugoe S., Mueller J., Kijima F., Aridome K., Shimada M., Shirao K., Kusano C., Baba M., Yoshinaka H., Fukumoto T. Extranodal connective tissue invasion and the expression of desmosomal glycoprotein 1 in squamous cell carcinoma of the oesophagus. Br J Cancer. 1997;75(6):892–897. doi: 10.1038/bjc.1997.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Natsugoe S., Yoshinaka H., Morinaga T., Shimada M., Baba M., Fukumoto T., Stein H. J., Aikou T. Ultrasonographic detection of lymph-node metastases in superficial carcinoma of the esophagus. Endoscopy. 1996 Oct;28(8):674–679. doi: 10.1055/s-2007-1005575. [DOI] [PubMed] [Google Scholar]
  12. Okuma T., Kaneko H., Yoshioka M., Torigoe Y., Miyauchi Y. Prognosis in esophageal carcinoma with cervical lymph node metastases. Surgery. 1993 Sep;114(3):513–518. [PubMed] [Google Scholar]
  13. Rubaltelli L., Proto E., Salmaso R., Bortoletto P., Candiani F., Cagol P. Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. AJR Am J Roentgenol. 1990 Dec;155(6):1241–1244. doi: 10.2214/ajr.155.6.2122673. [DOI] [PubMed] [Google Scholar]
  14. Tachimori Y., Kato H., Watanabe H., Yamaguchi H. Neck ultrasonography for thoracic esophageal carcinoma. Ann Thorac Surg. 1994 May;57(5):1180–1183. doi: 10.1016/0003-4975(94)91352-8. [DOI] [PubMed] [Google Scholar]
  15. Tio T. L., Cohen P., Coene P. P., Udding J., den Hartog Jager F. C., Tytgat G. N. Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system. Gastroenterology. 1989 Jun;96(6):1478–1486. doi: 10.1016/0016-5085(89)90515-5. [DOI] [PubMed] [Google Scholar]
  16. Vilgrain V., Mompoint D., Palazzo L., Menu Y., Gayet B., Ollier P., Nahum H., Fekete F. Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR Am J Roentgenol. 1990 Aug;155(2):277–281. doi: 10.2214/ajr.155.2.2115251. [DOI] [PubMed] [Google Scholar]
  17. Yoshinaka H., Nishi M., Kajisa T., Kuroshima K., Morifuji H. Ultrasonic detection of lymph node metastases in the region around the celiac axis in esophageal and gastric cancer. J Clin Ultrasound. 1985 Mar-Apr;13(3):153–160. doi: 10.1002/jcu.1870130302. [DOI] [PubMed] [Google Scholar]
  18. Yoshinaka H., Shimazu H., Fukumoto T., Baba M. Superficial esophageal carcinoma: a clinicopathological review of 59 cases. Am J Gastroenterol. 1991 Oct;86(10):1413–1418. [PubMed] [Google Scholar]

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