Abstract
ObjectivesTo investigate the additional value of cervical ultrasonography over 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.MethodsBetween January 2013 and January 2016, 163 patients with newly diagnosed oesophageal cancer underwent both cervical ultrasonography and 18F-FDG PET/CT at a tertiary referral centre in the Netherlands. Retrospective clinical data analysis was performed to assess the diagnostic value of cervical ultrasonography and 18F-FDG PET/CT for the detection of cervical lymph node metastases. Fine needle aspiration or clinical follow-up was used as reference standard.ResultsThe overall incidence of patients with cervical lymph node metastases was 14%. The sensitivity of 18F-FDG PET/CT to detect cervical lymph node metastases was 82% (95% CI 59–94%) and specificity was 91% (95% CI 85–95%). The sensitivity and specificity of cervical ultrasonography were 73% (95% CI 50–88%) and 84% (95% CI 77–90%), respectively. In patients with a negative 18F-FDG PET/CT, 12 of 133 (9%) patients had suspicious nodes on cervical ultrasonography. In all these 12 patients the nodes were confirmed benign.ConclusionsCervical ultrasonography has no additional diagnostic value to a negative integrated 18F-FDG PET/CT for the detection of cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.Key Points• Cervical ultrasonography has no value over PET/CT in evaluating cervical node metastases.• PET/CT provides greater diagnostic confidence compared to cervical ultrasonography.• Cervical ultrasonography during standard diagnostic work-up may be considered unnecessary.• Cervical lesions on PET/CT require cytopathological confirmation by FNA.
Highlights
Oesophageal cancer is the eighth most prevalent cancer, and the sixth most common cause of cancer-related death worldwide [1]
computed tomography (CT) to detect cervical lymph node metastases was 82% and specificity was 91%
The sensitivity and specificity of cervical ultrasonography were 73% and 84%, respectively
Summary
Oesophageal cancer is the eighth most prevalent cancer, and the sixth most common cause of cancer-related death worldwide [1]. Surgical resection of the oesophagus with en bloc lymphadenectomy remains the cornerstone treatment with curative intent for patients with non-metastatic oesophageal cancer [2, 3]. Accurate staging of oesophageal cancer is essential to select patients that are eligible for treatment with curative intent, and to identify patients with distant metastases to prevent a. In some guidelines the use of cervical ultrasonography is recommended since this is considered an effective and accurate approach to assess cervical lymph node involvement [7, 8]. The additional role of cervical ultrasonography for the detection of cervical lymph node metastases in the current era of routine diagnostic 18F-FDG PET/CT imaging may be limited
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