Abstract
BackgroudThe incidence of recurrent laryngeal nerve (RLN) injury has increased due to RLN lymph node dissection. The aim of this study was to evaluate the ability of intraoperative ultrasonography (IU) to detect RLN nodal metastases in esophageal cancer patients.MethodsSixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared.ResultsThe sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4, 14.3, and 30.0%, respectively, and a significant difference among these three examinations was observed (χ2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4, 97.8, and 95.0%, respectively, and a significant difference was observed (χ2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7, 16.7, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (χ2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2, 100, and 82.5%, respectively and a significant difference was observed (χ2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases.ConclusionIntraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer.
Highlights
Esophageal cancer is one of the most common cancers in the world, with more than 455,800 new cases and 400,200 deaths occurring annually worldwide [1]
endoscopic ultrasonography (EUS) could not be performed in 10 patients due to severe esophageal stenosis (7 cases) and suspicious perforation of tumor (3 cases)
There was a significant difference in the diagnostic sensitivities of these examinations (χ2 = 10.077, P = .006) which indicated that intraoperative ultrasonography (IU) had greater sensitivity than computed tomography (CT) and EUS
Summary
Esophageal cancer is one of the most common cancers in the world, with more than 455,800 new cases and 400,200 deaths occurring annually worldwide [1]. In. China, over 90% of all cases of esophageal cancer are secondary to squamous cell carcinoma. Esophageal squamous cell carcinoma often metastasizes to thoracic recurrent laryngeal nerve (RLN) lymph nodes. Determining whether or not RLN lymph nodes are involved is important in assessing the spread of the cancer. RLN lymph node dissection plays an important role in the treatment of esophageal cancer. RLN nodal dissection can provide accurate staging, achieve R0 resection, and improve prognosis. There has been no reliable procedure other than systematic RLN
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