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DOI: 10.1055/s-0032-1309817
Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard
Publication History
received 13 June 2011
accepted after revision 15 March 2012
Publication Date:
02 July 2012 (online)
![](https://www.thieme-connect.de/media/endoscopy/201208/lookinside/thumbnails/10.1055-s-0032-1309817-1.jpg)
Background and study aims: Accurate lymph node staging is essential for the selection of an optimal treatment in patients with upper gastrointestinal cancer. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are considered to be the most accurate method for locoregional staging. Endoscopic sonoelastography (ESE) assesses the elasticity of lymph nodes and has been used to differentiate lymph nodes with promising results. The aim of this study was to evaluate the use of EUS, EUS – FNA, ESE, and ESE-strain ratio using histology as the gold standard.
Patients and methods: Patients with upper gastrointestinal cancer who were referred for EUS examination were enrolled if surgical treatment was planned and the patient had a lymph node that was accessible for EUS – FNA and EUS-guided fine-needle marking (FNM). The lymph node was classified using EUS, ESE, and ESE-strain ratio. Finally, EUS – FNA and EUS – FNM were performed. The marked lymph node was isolated during surgery for histological examination.
Results: The marked lymph node was isolated for separate histological examination in 56 patients, of whom 22 (39 %) had malignant lymph nodes and 34 (61 %) had benign lymph nodes. There were no complications of EUS – FNM. The sensitivity of EUS for differentiation between malignant and benign lymph nodes was 86 % compared with 55 % – 59 % for the different ESE modalities. The specificity of EUS was 71 % compared with 82 % – 85 % using ESE modalities.
Conclusion: The use of the EUS – FNM technique enabled the identification of a specific lymph node and thereby the use of histology as gold standard. ESE and ESE-strain ratio were no better than standard EUS in differentiating between malignant and benign lymph nodes in patients with resectable upper gastrointestinal cancer.
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References
- 1 Schomas DA, Quevedo JF, Donahue JM et al. The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic. Dis Esophagus 2010; 23: 232-239
- 2 Natsugoe S, Yoshinaka H, Shimada M et al. Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma. Ann Surg 2001; 234: 613-618
- 3 Kelly S, Harris KM, Berry E et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 2001; 49: 534-539
- 4 Puli SR, Reddy JBK, Bechtold ML et al. Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 2008; 14: 1479-1490
- 5 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: 628-633
- 6 Giovannini M, Monges G, Seitz JF et al. Distant lymph node metastases in esophageal cancer: impact of endoscopic ultrasound-guided biopsy. Endoscopy 1999; 31: 536-540
- 7 Puli SR, Reddy JBK, Bechtold ML et al. Accuracy of endoscopic ultrasound in the diagnosis of distal and celiac axis lymph node metastasis in esophageal cancer: a meta-analysis and systematic review. Dig Dis Sci 2008; 53: 2405-2414
- 8 van Vliet EPM, Heijenbrok-Kal MH, Hunink MGM et al. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 2008; 98: 547-557
- 9 Vazquez-Sequeiros E, Wiersema MJ, Clain JE et al. Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology 2003; 125: 1626-1635
- 10 Vazquez-Sequeiros E, Levy MJ, Clain JE et al. Routine vs. selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma.. Gastrointest Endosc 2006; 63: 204-211
- 11 Giovannini M, Hookey LC, Bories E et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients.. Endoscopy 2006; 38: 344-348
- 12 Giovannini M, Thomas B, Erwan B et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol 2009; 15: 1587-1593
- 13 Janssen J, Dietrich CF, Will U et al. Endosonographic elastography in the diagnosis of mediastinal lymph nodes. Endoscopy 2007; 39: 952-957
- 14 Saftoiu A, Vilmann P, Hassan H et al. Analysis of endoscopic ultrasound elastography used for characterisation and differentiation of benign and malignant lymph nodes. Ultraschall Med 2006; 27: 535-542
- 15 Saftoiu A, Vilmann P, Ciurea T et al. Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes. Gastrointest Endosc 2007; 66: 291-300
- 16 Paterson S, Duthie F, Stanley A. EUS guided elastography evaluation of lymph nodes in esophago-gastric cancers. Gastrointest Endosc 2010; 71: AB225
- 17 Larsen MH, Fristrup CW, Pless T et al. Endoscopic ultrasound-guided fine-needle marking of lymph nodes. Endoscopy 2010; 42: 133-137
- 18 Catalano MF, Sivak Jr MV, Rice T et al. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc 1994; 40: 442-446
- 19 Itoh A, Ueno E, Tohno E et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006; 239: 341-350
- 20 Chang KJ. Maximizing the yield of EUS-guided fine-needle aspiration. Gastrointest Endosc 2002; 56 (04) 28-S34
- 21 Vilmann P, Saftoiu A. Endoscopic ultrasound-guided fine needle aspiration biopsy: equipment and technique. J Gastroenterol Hepatol 2006; 21: 1646-1655
- 22 Gleeson FC, Kipp BR, Caudill JL et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut 2010; 59: 586-593
- 23 Pishvaian AC, Collins B, Gagnon G et al. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 2006; 64: 412-417
- 24 Jenssen C, Dietrich CF. Endoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology – an overview. Best Pract Res Clin Gastroenterol 2009; 23: 743-759
- 25 Puli SR, Batapati Krishna RJ, Bechtold ML et al. How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review.. World J Gastroenterol 2008; 14: 4011-4019
- 26 Bardales RH, Stelow EB, Mallery S et al. Review of endoscopic ultrasound-guided fine-needle aspiration cytology. Diagn Cytopathol 2006; 34: 140-175
- 27 Cleveland P, Gill KRS, Coe SG et al. An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes. Gastrointest Endosc 2010; 71: 1194-1199
- 28 Eltoum IA, Chhieng DC, Jhala D et al. Cumulative sum procedure in evaluation of EUS-guided FNA cytology: the learning curve and diagnostic performance beyond sensitivity and specificity. Cytopathology 2007; 18: 143-150
- 29 Puli SR, Reddy JBK, Bechtold ML et al. Endoscopic ultrasound: it’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review.. World J Gastroenterol 2008; 14: 3028-3037
- 30 Bhutani MS, Hawes RH, Hoffman BJ. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc 1997; 45: 474-479
- 31 Gill KR, Ghabril MS, Jamil LH et al. Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. Gastrointest Endosc 2010; 72: 265-271
- 32 Mortensen MB, Pless T, Durup J et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy 2001; 33: 478-483
- 33 Larsen MH, Fristrup CW, Mortensen MB. Intra- and interobserver agreement of endoscopic sonoelastography in the evaluation of lymph nodes. Ultraschall Med 2011; 32: 45-50
- 34 Hirche TO, Ignee A, Barreiros AP et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy 2008; 40: 910-917
- 35 Meining A, Rosch T, Wolf A et al. High interobserver variability in endosonographic staging of upper gastrointestinal cancers. Z Gastroenterol 2003; 41: 391-394