Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer.

AIM To assess quantitative endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophago-gastric cancers. METHODS This was a single tertiary centre study assessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS characteristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers. RESULTS EUS elastography and FNAB were performed on 53 lymph nodes. Cytological malignancy was found in 23 nodes, one was indeterminate, one was found to be a gastrointestinal stromal tumor and 25 of the nodes were negative for malignancy. On 3 occasions insufficient material was obtained for analysis. The area under the curve for the receiver operating characteristic curve for elastography strain ratio was 0.87 (P < 0.0001). Elastography strain ratio had a sensitivity 83%, specificity 96%, positive predictive value 95%, and negative predictive value 86% for distinguishing between malignant and benign nodes. The overall accuracy of elastography strain ratio was 90%. Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria. CONCLUSION EUS elastography is a promising modality that may complement standard EUS and help guide EUS-FNAB during staging of upper gastrointestinal tract cancer.

[1]  H. Ishwaran,et al.  Cancer of the esophagus and esophagogastric junction , 2010, Cancer.

[2]  G. Monges,et al.  Endoscopic Ultrasound Elastography: the First Step towards Virtual Biopsy? Preliminary Results in 49 Patients , 2006, Endoscopy.

[3]  H. Matsubara,et al.  The significance of lymph node status as a prognostic factor for esophageal cancer , 2011, Surgery Today.

[4]  E. Kuipers,et al.  Staging investigations for oesophageal cancer: a meta-analysis , 2008, British Journal of Cancer.

[5]  P. Vilmann,et al.  Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management , 2002, Thorax.

[6]  M. Giovannini,et al.  Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. , 2009, World journal of gastroenterology.

[7]  Kenneth J. Chang,et al.  Staging Accuracy of Endoscopic Ultrasound Based on Pathologic Analysis after Minimally Invasive Esophagectomy , 2010, The American surgeon.

[8]  J. Ibdah,et al.  Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. , 2008, World journal of gastroenterology.

[9]  Wei Li,et al.  The value of ultrasound elastography in differential diagnosis of superficial lymph nodes , 2009 .

[10]  J. Janssen,et al.  EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. , 2007, Gastrointestinal endoscopy.

[11]  C. Compton,et al.  The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM , 2010, Annals of Surgical Oncology.

[12]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[13]  R. Nayar,et al.  Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA): experience of an academic centre in the USA , 2010, Cytopathology : official journal of the British Society for Clinical Cytology.

[14]  Ruey-Feng Chang,et al.  Solid breast masses: classification with computer-aided analysis of continuous US images obtained with probe compression. , 2005, Radiology.

[15]  Katsuhide Ito,et al.  Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. , 2008, AJR. American journal of roentgenology.

[16]  Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients , 2000 .

[17]  V. de Lédinghen,et al.  Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. , 2005, Gastroenterology.

[18]  V. de Lédinghen,et al.  Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study , 2005, Gut.

[19]  Adrian Saftoiu,et al.  Endoscopic ultrasound elastography-- a new imaging technique for the visualization of tissue elasticity distribution. , 2006, Journal of gastrointestinal and liver diseases : JGLD.

[20]  V. Chen,et al.  Endoscopic Ultrasound-Guided Fine Needle Aspiration is Superior to Lymph Node Echofeatures: A Prospective Evaluation of Mediastinal and Peri-Intestinal Lymphadenopathy , 2004, American Journal of Gastroenterology.

[21]  J Janssen,et al.  Endosonographic elastography in the diagnosis of mediastinal lymph nodes. , 2007, Endoscopy.

[22]  R Moreno-Otero,et al.  Transient elastography: a valid alternative to biopsy in patients with chronic liver disease , 2006, Alimentary pharmacology & therapeutics.

[23]  D. Faigel.  EUS in patients with benign and malignant lymphadenopathy , 2001 .

[24]  A. Fritscher-Ravens.  Blue Clouds and Green Clouds: Virtual Biopsy via EUS Elastography? , 2006, Endoscopy.

[25]  K. Togashi,et al.  Thyroid gland tumor diagnosis at US elastography. , 2005, Radiology.

[26]  P. Vilmann,et al.  Analysis of endoscopic ultrasound elastography used for characterisation and differentiation of benign and malignant lymph nodes. , 2006, Ultraschall in der Medizin.

[27]  M. Catalano,et al.  Endosonographic features predictive of lymph node metastasis. , 1994, Gastrointestinal endoscopy.