External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

被引：7
作者：
Blom, R. L. G. M. [1 ]
Vliegen, R. F. A. [2 ]
Schreurs, W. M. J. [3 ]
Belgers, H. J. [1 ]
Stohr, I. [4 ]
Oostenbrug, L. E. [4 ]
Sosef, M. N. [1 ]
机构：
[1] Atrium Med Ctr, Dept Surg, NL-6419 PC Heerlen, Netherlands
[2] Atrium Med Ctr, Dept Radiol, Heerlen, Netherlands
[3] Atrium Med Ctr, Dept Nucl Med, Heerlen, Netherlands
[4] Atrium Med Ctr, Dept Internal Med, Heerlen, Netherlands
来源：
DISEASES OF THE ESOPHAGUS | 2012年 / 25卷 / 06期
关键词：
cervical lymph node; diagnosis; esophageal carcinoma; metastasis; ultra-sound-guided-fine-needle cytology;
D O I：
10.1111/j.1442-2050.2011.01289.x
中图分类号：
R57 [消化系及腹部疾病];
学科分类号：
摘要：
One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan.
引用
收藏
页码：555 / 559
页数：5
相关论文
共 23 条
  • [1] Jemal A., Siegel R., Ward E., Et al., Cancer statistics, 2007, CA Cancer J Clin, 57, pp. 43-66, (2007)
  • [2] Pohl H., Welch H.G., The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence, J Natl Cancer Inst, 97, pp. 142-146, (2005)
  • [3] Kamangar F., Dores G.M., Anderson W.F., Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world, J Clin Oncol, 24, pp. 2137-2150, (2006)
  • [4] Bollschweiler E., Wolfgarten E., Gutschow C., Et al., Demographic variations in the rising incidence of esophageal adenocarcinoma in white males, Cancer, 92, pp. 549-555, (2001)
  • [5] Devesa S.S., Blot W.J., Fraumeni Jr. J.F., Changing patterns in the incidence of esophageal and gastric carcinoma in the United States, Cancer, 83, pp. 2049-2053, (1998)
  • [6] Graham A.J., Shrive F.M., Ghali W.A., Et al., Defining the optimal treatment of locally advanced esophageal cancer: a systematic review and decision analysis, Ann Thorac Surg, 83, pp. 1257-1264, (2007)
  • [7] Allum W.H., Griffin S.M., Watson A., Et al., Guidelines for the management of oesophageal and gastric cancer, Gut, 50, 5 SUPPL., (2002)
  • [8] Siersema P.D., Rosenbrand C.J., Bergman J.J., Et al., Guideline 'Diagnosis and treatment of oesophageal carcinoma, Ned Tijdschr Geneeskd, 150, pp. 1877-1882, (2006)
  • [9] van Heijl M., Omloo J.M., van Berge Henegouwen M.I., Et al., Diagnostic strategies for pre-treatment staging of patients with oesophageal cancer, Dig Surg, 26, pp. 149-155, (2009)
  • [10] Noble F., Bailey D., Tung K., Et al., Impact of integrated PET/CT in the staging of oesophageal cancer: a UK population-based cohort study, Clin Radiol, 64, pp. 699-705, (2009)
123