Download PDF
Endoscopy 1999; 31(7): 536-540
DOI: 10.1055/s-1999-60
Original Article
Georg Thieme Verlag Stuttgart · New York

Distant Lymph Node Metastases in Esophageal Cancer: Impact of Endoscopic Ultrasound-Guided Biopsy

M. Giovannini 1 , G. Monges 2 , J. F. Seitz 3 , V. Moutardier 4 , D. Bernardini 3 , P. Thomas 5 , G. Houvenaeghel 4 , J. R. Delpero 4 , R. Giudicelli 5 , P. Fuentes 5
  • 1 Endoscopic Unit, Paoli-Calmettes Institute, Marseilles, France 2 Anatomo-pathologic Unit, Paoli-Calmettes Institute, Marseilles, France 3 Oncology Unit. Paoli-Calmettes Institute, Marseilles, France 4 Dept. of Surgery, Paoli-Calmettes Institute, Marseilles, France 5 Dept. of Thoracic Surgery, Ste Marguerite Hospital, Marseilles, France
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: The aim of this retrospective study was to evaluate the impact of endoscopic ultrasound (EUS)-guided biopsy in patients with esophageal carcinoma where distant lymph nodes which were possibly metastatic were visualized using EUS.

Patients and Methods: Out of 198 patients (150 men, mean age 66 years) examined over a 4-year period by EUS for local staging of esophageal cancer (121 squamous cell carcinomas and 77 adenocarcinomas), there was EUS visualization of distant lymph nodes in 40 (20 %). EUS-guided biopsy was carried out in the latter patients, of cervical nodes with mediastinal tumors (n = 19), of celiac nodes with cervical tumors (n = 2) or superior mediastinal tumors (n = 9), and upper mediastinal lymph nodes in the case of distal adenocarcinomas (n = 10).

Results: On EUS-guided biopsy, results were positive in 31 patients, eight were correctly negative (as confirmed by surgery), and in one patient there was a technical failure, with positive findings on subsequent surgery. The sensitivity and specificity of the diagnosis of malignant lymph nodes were therefore 97 % and 100 % respectively. The positive results of EUS-guided biopsy modified the tumor staging in 31 of these cases (77.5 %), proving distant lymph node metastasis which is classified as stage M1. With regard to actual clinical management, surgery was withheld from 24 patients (60 % of 40 cases) who were then treated with concomitant radiotherapy and chemotherapy.

Conclusion: EUS-guided biopsy of distant lymph nodes was indicated in 20 % of patients with esophageal cancers, and the biopsy results led to upgrading of the tumor stage in about 80 % of cases and influenced the treatment decision in about 60 %.

Buts de l'étude: Le but de cette étude rétrospective a été d'évaluer l'impact de la biopsie guidée sous échoendoscopie (EE) de patients présentant un cancer de l'oesophage chez qui l'EE avait mis en évidence des ganglions distaux pouvant être potentiellement des métastases.

Patients et Méthodes: Parmi les 198 patients (150 hommes, âge moyen 66 ans) ayant eu une EE pour le staging d'un cancer de l'oesophage (121 carcinomes épidermoïdes, 77 adénocarcinomes) durant une période de 4 ans, 40 présentaient des ganglions distaux (20 %). Parmi ces patients, une biopsie guidée sous EE a été réalisée en cas de ganglions cervicaux pour des tumeurs médiastinales (n = 19), en cas de ganglions coeliaques pour des cancers cervicaux (n = 2) ou pour des lésions médiastinales supérieures (n = 9) et enfin en cas de ganglions médiastinaux supérieurs pour les adénocarcinomes du l'oesophage inférieur (n = 10).

Résultats: La biopsie sous EE a été positive dans 31 cas, négative (lymphocytes normaux) dans 8 cas (confirmé chirurgicalement). Dans 1 cas la biopsie n'a pas été contributive et le ganglion était métastatique lors de la résection chirurgicale. La sensibilité et la spécificité pour le diagnostic de malignité des ganglions ont été respectivement de 97 et 100 %. Le stade tumoral a été modifié par la biopsie guidée sous EE dans 31 cas (77.5 %), ces tumeurs etant classées M1, et 24 patients (60 % des 40 patients) ont été récusés pour une résection chirurgicale et ont été traités par une radio-chimiothérapie concomitante.

Conclusion: Dans cette étude une biopsie guidée sous EE de ganglions distaux a été indiquée dans 20 % des cas pour des patients porteurs d'un cancer de l'oesophage. Le résultat de la biopsie guidée sous EE a modifié le staging tumoral et la décision thérapeutique dans 80 et 60 % des cas respectivement.

References

  • 1 Vilgrain V, Mompoint D, Palazzo L, et al. Staging of oesophageal carcinoma: comparison of results with endoscopic sonography and CT.  Am J Roentgenol. 1990;  155 277-281
    PubMedGoogle Scholar
  • 2 Ziegler K, Sanft C, Zeitz M, et al. Evaluation of endosonography in TN staging of esophageal carcinoma.  Gut,. 1991;  32 16-20
    PubMedGoogle Scholar
  • 3 Tio TL, Cohen P, Coenne PP, et al. Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system.  Gastroenterology. 1989;  96 1478-1486
    PubMedGoogle Scholar
  • 4 Palazzo L, Gayet B, Vilgrain V, Molas G. Echo-endoscopie et cancer de l'oesophage: résultats d'une étude prospective et comparative avec la tomodensitométrie chez 51 malades opérés.  Gastroenterol Clin Biol. 1990;  14 428-436
    PubMedGoogle Scholar
  • 5 Nattermann C, Dancygier H. Endoskopischer Ultraschall im präoperativen TN-staging des ösophaguskarzinoms: eine vergleichende Studie zwischen Endosonographie und Computertomographie.  Ultraschall Med. 1993;  14 100-105
    PubMedGoogle Scholar
  • 6 Dittler HJ, Siewert JR. Role of endoscopic ultrasonography in esophageal carcinoma.  Endoscopy. 1993;  25 156-161
    PubMedGoogle Scholar
  • 7 Hordijk ML, Zander H, Van Blankenstein M, Tilanus HW. Influence of tumor stenosis on the accuracy of endosonography in preoperative T staging of esophageal cancer.  Endoscopy. 1993;  25 171-175
    PubMedGoogle Scholar
  • 8 Van Dam J, Rice TW, Catalano MF, et al. High-grade malignant stricture is predictive of esophageal tumor stage. Risks of endosonographic evaluation.  Cancer. 1993;  71 2910-2917
    PubMedGoogle Scholar
  • 9 Grimm H, Binmoeller KF, Hamper K, et al. Endosonography for preoperative locoregional staging of esophageal and gastric cancer.  Endoscopy. 1993;  25 224-230
    PubMedGoogle Scholar
  • 10 Palazzo L, Gayet B, Roseau G, et al. Superficial esophageal carcinoma (EC), the role of endoscopic ultrasonography (EUS): results of a prospective study.  Gastroenterology. 1992;  102 A385a
    PubMedGoogle Scholar
  • 11 Tio TL, Den Hartog Jager FC, Tytgat GN. The role of endoscopic ultrasonography in assessing local resectability of esophagogastric malignancies: accuracy, pitfalls and predictability.  Scand J Gastroenterol. 1986;  21 (Suppl.) 78-86
    PubMedGoogle Scholar
  • 12 Giovannini M, Seitz JF, Monges G, et al. Fine needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
    PubMedGoogle Scholar
  • 13 Giovannini M, Seitz JF, Perrier H, et al. Endosonography guided fine needle aspiration biopsy in submucosa and extrinsic tumors of gastrointestinal tract. Preliminary results in 31 patients [abstract].  Gastroenterology. 1993;  104 A405
    PubMedGoogle Scholar
  • 14 Vilmann P, Hancke S, Henriksen FW, Jacobsen GK. Endoscopic ultrasonography with fine needle aspiration biopsy in pancreatic disease.  Endoscopy. 1993;  25 523-527
    PubMedGoogle Scholar
  • 15 Wegener M, Adamek RJ, Wedmann B, Pfaffenbach B. Endosonographically guided fine-needle aspiration puncture of paraesophagogastric mass lesions: preliminary results.  Endoscopy. 1994;  26 586-591
    PubMedGoogle Scholar
  • 16 Chang KJ, Katz KD, Durbin TE, et al. Endoscopic ultrasound guided fine-needle aspiration.  Gastrointest Endosc. 1994;  40 694-699
    PubMedGoogle Scholar
  • 17 Wiersema MJ, Kochman ML, Cramer HM, et al. Endosonography-guided real-time fine-needle aspiration biopsy.  Gastrointest Endosc. 1994;  40 700-707
    PubMedGoogle Scholar
  • 18 Ikenberry S, Gress F, Olivier S, Winberg J. Fine needle aspiration guided by radial scanning endosonography (RSE) of lesions throughout the gastrointestinal tract.  Gastrointest Endosc. 1996;  43 536-424
    PubMedGoogle Scholar
  • 19 Vilmann P, Hancke S. A new biospy handle instrument for endoscopic ultrasound-guided fine needle aspiration biopsy.  Gastrointest Endosc. 1996;  43 (3) 238-242
    PubMedGoogle Scholar
  • 20 Wiersema M, Vilmann P, Giovannini M, Chang KJ. Prospective multi-center evaluation of endoscopic ultrasound (EUS)-guided fine-needle aspiration biopsy (FNA): diagnostic accuracy and complication assessment.  Gastrointest Endosc. 1996;  43 566-432
    PubMedGoogle Scholar
  • 21 Chang KJ, Wiersema M, Giovannini M, et al. Multi-center collaborative study on endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of the pancreas.  Gastrointest Endosc. 1996;  43 507-417
    PubMedGoogle Scholar
  • 22 Hiele M, De Leyn P, Schurmans P, et al. Relation between EUS findings and outcome of patients with tumors of the esophagus or esophagogastric junction.  Gastrointest Endosc. 1997;  45 (5) 381-386
    PubMedGoogle Scholar
  • 23 Siemsen M, Jensen DB, Rasch L, et al. Endosonography in the preoperative staging in oesophageal cancer.  Endoscopy. 1997;  29 E8
    PubMedGoogle Scholar
  • 24 Binmoeller K, Rathod VD, Frey M, et al. EUS-guided FNAB for N and M staging of lymph nodes associated with esophageal and cardia malignancies.  Endoscopy. 1997;  29 E9
    PubMedGoogle Scholar

M. GiovanniniM.D. 

Paoli-Calmettes Institute

232 bd Ste-Marguerite

13273 Marseilles Cedex 9

France

Phone: + 33-4-91223650

Email: hdjchir@marseille.fnclcc.fr

      >