OGC P64 Additional value of cervical ultrasonography in the detection of cervical lymph node metastases in patients with esophageal cancer

Abstract

Abstract Background External ultrasound for detection of cervical lymph node metastases used to be standard in the diagnostic work-up for esophageal cancer patients in the Netherlands. This study aimed to assess the additional value of cervical ultrasonography over 18F-FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients. Methods This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed for presence of suspect cervical lymph node(s). Primary outcome was incidence, etiology and visibility on ultrasound and/or 18F-FDG PET-CT. Results This study included 789 patients, with a median age of 67 years. Patients were predominantly male (75.2%) and the majority had an adenocarcinoma (71.7%). Suspected cervical lymph nodes were documented in 170 patients (21.6%), 57 proved malignant (33.5%). Of these malignant lymph nodes, seven (12.3%) were visualized on ultrasound, but negative on 18F-FDG PET-CT. One was detected with 18F-FDG PET-CT but not visualized on ultrasound. Lymph node biopsy was conducted for 150 out of 170 patients. Of those, 79 proved benign. 60 patients underwent biopsy for a benign cervical lymph node suspected on ultrasound but negative on 18F-FDG PET-CT. Conclusions As 12.3% of malignant cervical lymph nodes were only visualized with ultrasound, but negative on 18F-FDG PET-CT, cervical ultrasound is of additional value in the detection of cervical lymph node metastases. However, routine cervical ultrasound also attributes to the number of biopsies taken for benign lesions.