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Sonographic characteristics of locoregional lymph nodes that can predict the presence of metastatic carcinoma by endoscopic ultrasound-guided fine needle aspiration in patients with carcinomas of the esophagus/gastroesophageal junction

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Abstract

Background

Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (EUS-FNA) of lymph nodes (LN) are used for preoperative staging of patients with esophageal/gastroesophageal junction (E/GEJ) carcinomas. The recognition of sonographic features of LN can be variable in selecting LN for EUS-FNA. We evaluated the predictive value of sonographic features of LNs that correlate with the presence of metastatic carcinoma by EUS-FNA.

Materials and methods

Patients with GIPB who underwent EUS/EUS-FNA for the preoperative staging of LNs over 29 months were studied. The EUS features including size, shape, borders, and echogenicity along with primary tumor stage were evaluated/correlated with the EUS-FNA result to determine features that predict positive EUS-FNA results.

Results

86 LNs from 74 patients with E/GEJ carcinomas were studied. FNA yielded a positive/suspicious for carcinoma diagnosis in 42 cases and a negative result in 44 cases. The sonographic features of the LNs with and without metastatic carcinoma were average short axis measurement (1.02 vs 0.73), average long axis measurement (1.413 vs 1.348), average long:short axis ratio (1.45 vs 1.2), hypoechoic cortex (97.6 vs 72.8 %), round shape (71.4 vs 29.5 %), and well-circumscribed borders (40.5 vs 31.8 %). The features most strongly predictive of a positive result were short axis (p = 0.006), hypoechoic cortex (p = 0.01), and round shape (p = 0.0005) on univariate analysis. High-primary tumor stage (T3 and T4, p = 0.07 and p = 0.27, respectively) did not predict metastatic carcinoma on EUS-FNA. On multivariate analysis, short axis measurement alone was strongly predictive of a positive EUS-FNA (p = 0.04).

Conclusions

Sonographic features of LNs including size, shape, echogenicity, and border characteristics can be useful in the selection of pertinent LNs for EUS-FNA sampling in preoperative staging of E/GEJ malignancies based on their ability to predict the presence of metastatic carcinoma. While hypoechoic cortex, round shape, and short axis measurement were independent factors that strongly predicted the presence of metastatic carcinoma on EUS-FNA, short axis alone was strongly predictive of metastatic carcinoma on multivariate analysis.

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References

  1. Vasquez-Sequeros E, Wiersema M, Clain J, et al. Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology. 2003;125:1626–35.

    Article  Google Scholar 

  2. Lowe V, Booya F, Fletcher JG, et al. Comparison of positron emission tomography, computed tomography and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol. 2005;7:422–30.

    Article  PubMed  Google Scholar 

  3. Elouibedi M. Routine EUS-guided FNA for preoperative nodal staging in patients with esophageal carcinoma: is the juice worth the squeeze? Gastrointest Endosc. 2006;63:212–4.

    Article  Google Scholar 

  4. Kim L, Koch J. Do we practice what we preach? Clinical decision making and utilization of endoscopic ultrasound for staging esophageal cancer. Am J Gastroenterol. 1999;94:1847–51.

    Article  CAS  PubMed  Google Scholar 

  5. Catalano M, Sivak M, Rice T, et al. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc. 1994;40:442–6.

    Article  CAS  PubMed  Google Scholar 

  6. Mallery S, Van Dam J. EUS in the evaluation of esophageal carcinoma. Gastrointest Endosc. 2000;52:S6–11.

    Article  CAS  PubMed  Google Scholar 

  7. Hawes R. The evolution of endoscopic ultrasound: improved imaging, higher accuracy for fine needle aspiration and the reality of endoscopic ultrasound guided interventions. Curr Opin Gastroenterol. 2010;26:436–44.

    PubMed  Google Scholar 

  8. Chhieng D, Jhala D, Jhala N, et al. Endoscopic Ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases. Cancer Cytopathol. 2002;96(4):232–9.

    Article  Google Scholar 

  9. Zhang S, DeFrias V, Alasadi R, Nayar R. Endoscopic ultra-sound guided fine needle aspiration (EUS-FNA): experience of an academic centre in the USA. Cytopathology. 2010;21:35–43.

    Article  CAS  PubMed  Google Scholar 

  10. Vazquez-Sequeiros E, Levy M, Clain J, et al. Routine vs selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma. Gastrointest Endosc. 2006;63:204–11.

    Article  PubMed  Google Scholar 

  11. Chang K, Soetikno R, Bastas D, et al. Impact of endoscopic ultrasound combined with fine needle aspiration biopsy in the management of esophageal cancer. Endoscopy. 2003;11:962–5.

    Google Scholar 

  12. Galasso D, Carnuccio A, Larghi A. Pancreatic cancer: diagnosis and endoscopic staging. Eur Rev Med Pharmacol Sci. 2010;14:375–85.

    CAS  PubMed  Google Scholar 

  13. Harewood GC, Kumar KS. Assessment of clinical impact of endoscopic ultrasound on esophageal cancer. J Gastroenterol Hepatol. 2004;19:433–9.

    Article  PubMed  Google Scholar 

  14. Eloubeidi MA, Cerfolio RJ, Bryant AS, et al. Efficacy of endoscopic ultrasound in patients with esophageal cancer predicted to have N0 disease. Eur J Cardiothor Surg. 2011;40:636–41.

    Google Scholar 

  15. Dunn J, Lovat L. The role of endoscopic ultrasonography in Barrett’s esophagus and early esophageal cancer. Tech Gastrointest Endosc. 2010;12:12–7.

    Article  Google Scholar 

  16. Shami VM, Villaverde A, Stearns L, et al. Clinical impact of conventional endosonography and endoscopic ultra-sound guided fine needle aspiration in the assessment of patient’s with Barrett’s esophagus and high grade dysplasia or intramucosal carcinoma who have been referred for endoscopic ablation therapy. Endoscopy. 2006;38:157–61.

    Article  CAS  PubMed  Google Scholar 

  17. Kundu U, Weston B, Lee J, Hoffstetter W, Krishnamurthy S. Evolving role of endoscopic ultrasonography guided fine needle aspiration in tumor staging and treatment of patients with carcinomas of the upper gastrointestinal tract. J Am Soc Cytopathol. 2014;3:29–36.

    Article  Google Scholar 

  18. Evans J, Early D, Chandraskhara V, et al. The role of endoscopy in the assessment and treatment of esophageal cancer.ASGE Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 2013;77(3):328–34.

    Article  PubMed  Google Scholar 

  19. Jue T, Sharaf R, Appalaneni V, et al. The role of EUS for the evaluation of mediastinal adenopathy, ASGE Standards of Practice Committee. Gastrointest Endosc. 2011;74(2):239–45.

    Article  PubMed  Google Scholar 

  20. Dumonceau JM, Polkowski M, Larghi A, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. European Society of Gastrointestinal Endoscopy. Endoscopy. 2011;43(10):897–912.

    Article  PubMed  Google Scholar 

  21. de Melo S, Panjala C, Crespo S, et al. Interobserver agreement on the endosonographic features of lymph nodes in aerodigestive malignancies. Dig Dis Sci. 2011;56:3204–8.

    Article  PubMed  Google Scholar 

  22. Nickl N, Bhutani M, Catalano M, et al. Clinical implications of endoscopic ultrasound: the American Endosonography Club Study. Gastrointest Endosc. 1996;44:371–7.

    Article  CAS  PubMed  Google Scholar 

  23. Giovannini M, Monges G, Seitz J, et al. Distant lymph node metastases in esophageal cancer: impact of endoscopic ultra-sound guided biopsy. Endoscopy. 1999;31(7):536–40.

    Article  CAS  PubMed  Google Scholar 

  24. Wallace M, Nietert P, Earle C, et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thorascopy/laparoscopy. Ann Thorac Surg. 2002;74:1026–32.

    Article  PubMed  Google Scholar 

  25. Jhala N, Jhala D, Chhieng D, et al. Endoscopic ultrasound guided fine needle aspiration: a cytopathologists’ persepective. Am J Clin Pathol. 2003;120:351–67.

    Article  PubMed  Google Scholar 

  26. Peng H, Greenwald B, Tavora F, et al. Evaluation of performance of EUS-FNA in preoperative lymph node staging of cancer of esophagus, lung and pancreas. Diagn Cytopathol. 2008;36(5):290–6.

    Article  CAS  PubMed  Google Scholar 

  27. Bhutani MS, Hawes RH, Hoffman BJ. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc. 1997;45:474–9.

    Article  CAS  PubMed  Google Scholar 

  28. Schmulewitz N, Wildi S, Varadarajulu S, et al. Accuracy of EUS criteria and primary tumor sitefor identification of mediastinal lymph node metastasis from non-small cell lung cancer. Gastrointest Endosc. 2004;59:205–12.

    Article  PubMed  Google Scholar 

  29. Eloubeidi MA, Wallace MB, Reed CE, et al. The utility of EUS and EUS guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: a single-center experience. Gastrointest Endosc. 2001;54:714–9.

    Article  CAS  PubMed  Google Scholar 

  30. Gleeson FC, Rajan E, Levy MJ, et al. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc. 2008;67:438–43.

    Article  PubMed  Google Scholar 

  31. Faigel D. EUS in patients with benign and malignant adenopathy. Gastrointest Endosc. 2001;53:593–8.

    Article  Google Scholar 

  32. Chen V, Eloubeidi M. Endoscopic ultra-sound guided fine needle aspiration is superior to lymph node echofeatures:a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol. 2004;628–633.

  33. Hall J, Kahaleh M, White G, et al. Presence of lymph node vasculature: a new EUS criterion for benign nodes? Digest Dis Sci. 2009;54:118–21.

    Article  PubMed  Google Scholar 

  34. Ahuja A, Ying M. Grey scale sonography in assessment of cervical lymphadenopathy: review of sonographic appearances and features that may help a beginner. Br J Oral Maxillofac Surg. 2000;38:451–9.

    Article  CAS  PubMed  Google Scholar 

  35. Gleeson F, Clain J, Papachrisou G, et al. Prospective assessment of EUS criteria for lymphadenopathy associated with rectal cancer. Gastrointest Endosc. 2009;69:896–903.

    Article  PubMed  Google Scholar 

  36. Gill K, Marwan G, Jamil L, et al. Endosonographic features predictive of malignancy in mediastinal lymph nodes in patient with lung cancer. Gastrointest Endosc. 2010;72:265–70.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tio TL, Tytgat GN, Cikot RJ, et al. Ampullopancreatic carcinoma: preoperative TNM classification with endosonography. Radiology. 1990;175(2):455–61.

    Article  CAS  PubMed  Google Scholar 

  38. Bhutani M, Saftoiu A, Chaya C, et al. Irregular echogenic foci representing coagulation necrosis: a useful but perhaps under-recognized EUS echo feature of malignant lymph node invasion. J Gastrointest Liver Dis. 2009;18:181–4.

    Google Scholar 

  39. Brais R, Davies S, O’Donovan M, et al. Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials. Pancreatology. 2012;12:8–15.

    Article  CAS  PubMed  Google Scholar 

  40. Civardi G, Fornari F, Cavanna L, et al. Value of rapid staining andassessment of ultrasound guided fine needle aspiration biopsies. Acta Cytol. 1988;4:552–4.

    Google Scholar 

  41. Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung. J Clin Pathol. 1996;49:839–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Santambrogio L, Nosotti M, Bellaviti N, et al. CT-guided fine needle aspiration cytology of solitary pulmonary nodules: a prospective, randomized study of immediate cytologic evaluation. Chest. 1997;112:423–5.

    Article  CAS  PubMed  Google Scholar 

  43. Cleveland P, Rupinder K, Gill S, et al. An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes. Gastrointest Endosc. 2010;7:1194–7.

    Article  Google Scholar 

  44. Wallace M, Kennedy T, Durkalski V, et al. Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. Gastrointest Endosc. 2001;54:441–7.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Departments of Pathology, Gastroenterology and Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX, 77030, USA

    Uma Kundu, Brian Weston, Jeffrey H. Lee, Manoop S. Bhutani, William A. Ross, Wayne Hofstetter, Roland L. Bassett & Savitri Krishnamurthy

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  1. Uma Kundu
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  2. Brian Weston
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  3. Jeffrey H. Lee
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  4. Manoop S. Bhutani
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  8. Savitri Krishnamurthy
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Corresponding author

Correspondence to Uma Kundu.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

The authors Kundu U, Weston B, Lee J H, Bhutani M S, Ross W A, Hofstetter W, Bassett R, and Krishnamurthy S. declare that they have no conflict of interest.

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Kundu, U., Weston, B., Lee, J.H. et al. Sonographic characteristics of locoregional lymph nodes that can predict the presence of metastatic carcinoma by endoscopic ultrasound-guided fine needle aspiration in patients with carcinomas of the esophagus/gastroesophageal junction. Esophagus 13, 187–194 (2016). https://doi.org/10.1007/s10388-015-0514-4

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