Abstract
Esophageal cancer staging is important for the treatment of esophageal cancer. Endoscopic ultrasonography (EUS) is a common diagnostic tool for esophageal cancer prior to surgery. However, EUS is unable to accurately discriminate the N-staging of lymph nodes. In order to distinguish an optimized standard for malignant lymph node diagnosis, the present study compared lymph nodes detected by EUS and surgery. A total of 112 patients were preoperatively examined with EUS and staged according to the 7th Edition of the American Joint Committee on Cancer Staging Manual. The results of EUS were compared with surgical findings. The critical values of long diameter, short diameter and lymph node number detected by EUS were >7.5, >5.5 mm and >2, respectively; indexes, including long diameter >7.5 mm, short diameter >5.5 mm, round, low echo, edge smooth, near lesion and detected lymph node number (>2) and T3/4 staging, met significance in the EUS group compared with the surgical group (P<0.05). Furthermore, the area under curve (AUC) value of the EUS (0.801) was superior to the conventional, surgical method (0.779). Although EUS improved the diagnostic accuracy of esophageal N staging, it was not able to satisfactorily distinguish between N2 and N3 staging. Advancements in EUS may enhance its detection ability, further improving the diagnostic accuracy of lymph node metastasis.
Highlights
Esophageal cancer is a common malignant tumor in China [1]
Comparison of lymph nodes detected by Endoscopic ultrasonography (EUS) and those cleared by surgery determined the metastatic status of 225 lymph nodes; 48 detected by EUS had not been reported by surgical clearance, and were predominantly located at the tracheal and esophagus grooves
EUS used for T staging of esophageal cancer has been previously reported, where its accuracy is consistently high (73.2‐90%) [4,5,6,7]
Summary
Esophageal cancer is a common malignant tumor in China [1]. Surgical resection remains the primary treatment method. Preoperative understanding of the invasion depth and lymph node metastasis would be helpful in treatment approach choices. The TNM system is the most widely used cancer staging system, which is based on primary tumor (T), regional lymph nodes (N) and distant metastasis (M) [2]. The majority of hospitals and medical centers use the TNM system as their main method for cancer reporting. In the last 10 years, endoscopic ultrasonography has revealed the histological features of the esophagus and adjacent organs, allowing for more accurate TNM staging of esophageal cancer [3]. There remain a number of issues that require further study
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