Endoscopic Ultrasonography and Neck Ultrasonography in Evaluation of Esophageal Carcinoma

Yuji Tachimori, Hoichi Kato, Hiroshi Watanabe, Masayuki Itabashi*

Department of Surgery, National Cancer Center Hospital and Pathology Division*, National Cancer Center Research Institute

To study the accuracy and limitations of preoperative evaluation of esophageal carcinoma by endoscopic ultrasonography (EUS) and neck ultrasonography (NUS), ultrasonographic evaluation was compared with histological diagnosis of the depth of tumor invasion and lymph node metastasis. EUS was performed in 159 patients and NUS in 142 patients. Overall accuracy in estimation of depth of invasion by EUS was 70%, and 45% in cases with submucosal invasion. From the histological analysis of 29 carcinomas with submucosal invasion, it was presumed that the depth of invasion was interpreted as limited to the mucosa when a thick submucosal layer was lying under the tumor or width of submucosal invasion was small. In 9 out of 17 cases with a tumor invading adjacent structures, the probe could not pass through the stenosis caused by the tumor, and the accuracy was 53%. Although correct diagnosis was made by EUS in 83% of cases with lymph node metastasis in the mediastinum, sensitivity in each lymph node was low, especially in the right upper and the lower mediastinum, because of the dead angle due to the trachea and stenosis caused by the tumor. Correct diagnosis was made by NUS in 72% of cases with lymph node metastasis in the neck. Detection and diagnosis of metastatic lymph node under 5 mm in diameter was not feasible. EUS and NUS were useful for the decision about resectability, however, still more improvement is desired.

Key words
esophageal carcinoma, endoscopic ultrasonography, ultrasonography of cervical lymph node, evaluation of depth of tumor invasion, evaluation of lymph node metastasis

Reprint requests
Yuji Tachimori Department of Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
December 12, 1990

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