7059 Impact of endosonography guided fine needle aspiration biopsy (eus fna) on lymph node (ln) staging in patients with esophageal carcinoma.

Abstract

Background: Recognition of lymph node metastases in esophageal cancer may influence treatment decisions. regarding preoperative adjuvant therapy (N1) and/or surgical resection (M1a: celiac LN). EUS is the most accurate method for locoregional staging of these tumors, clearly superior to CT. To date, the role of EUS FNA in these patients has not been defined. Purpose: Determine if EUS FNA can improve the N staging accuracy of EUS in esophageal carcinoma. Methods: From May 1996 to May 1999, 74 consecutive patients with histologically proven esophageal carcinoma underwent preoperative EUS examination. The mean age was 64 years (range 43-84), male/female 68/6, and adeno/squamous cell carcinoma 65/9. After October 1998 EUS FNA was routinely performed on non-peritumoral lymph nodes >5 mm in width (31 patients sampled). Final diagnosis was made based on surgical results or EUS FNA malignant cytology. 8 patients were excluded from analysis due to unresectable disease. 29 patients did not proceed directly to surgery after EUS: T4 (2), N1 (15) or M1a (12) and adjuvant or palliative treatment was employed. 9 patients underwent dilatation: 2 were non-traversable after dilatation (both T3N1M0). 1 of 9 patients (11%) developed complications related to dilatation (self limited bleeding). No complications related with the EUS procedure or FNA registered. Results: N stage was obtained in 47 patients (EUS alone: 30 vs EUS FNA: 17). M1a stage was obtained in 51 patients (EUS: 37 vs EUS FNA: 14). CT staging accuracy for N stage was 40% and M stage 15%. EUS T stage global accuracy was 82% (95%CI: 76-88%). (See Table) Conclusions: 1) EUS FNA is more accurate and sensitive than EUS alone for preoperative, evaluation of periesophageal, perigastric and celiac LN when staging esophageal carcinoma. 2) EUS FNA of LN in patients with esophageal carcinoma is a safe method, and should be routinely performed when treatment decisions will be affected by nodal stage. Background: Recognition of lymph node metastases in esophageal cancer may influence treatment decisions. regarding preoperative adjuvant therapy (N1) and/or surgical resection (M1a: celiac LN). EUS is the most accurate method for locoregional staging of these tumors, clearly superior to CT. To date, the role of EUS FNA in these patients has not been defined. Purpose: Determine if EUS FNA can improve the N staging accuracy of EUS in esophageal carcinoma. Methods: From May 1996 to May 1999, 74 consecutive patients with histologically proven esophageal carcinoma underwent preoperative EUS examination. The mean age was 64 years (range 43-84), male/female 68/6, and adeno/squamous cell carcinoma 65/9. After October 1998 EUS FNA was routinely performed on non-peritumoral lymph nodes >5 mm in width (31 patients sampled). Final diagnosis was made based on surgical results or EUS FNA malignant cytology. 8 patients were excluded from analysis due to unresectable disease. 29 patients did not proceed directly to surgery after EUS: T4 (2), N1 (15) or M1a (12) and adjuvant or palliative treatment was employed. 9 patients underwent dilatation: 2 were non-traversable after dilatation (both T3N1M0). 1 of 9 patients (11%) developed complications related to dilatation (self limited bleeding). No complications related with the EUS procedure or FNA registered. Results: N stage was obtained in 47 patients (EUS alone: 30 vs EUS FNA: 17). M1a stage was obtained in 51 patients (EUS: 37 vs EUS FNA: 14). CT staging accuracy for N stage was 40% and M stage 15%. EUS T stage global accuracy was 82% (95%CI: 76-88%). (See Table) Conclusions: 1) EUS FNA is more accurate and sensitive than EUS alone for preoperative, evaluation of periesophageal, perigastric and celiac LN when staging esophageal carcinoma. 2) EUS FNA of LN in patients with esophageal carcinoma is a safe method, and should be routinely performed when treatment decisions will be affected by nodal stage.