Issn Print: 0954-691X
Publication Date: 2006/01/01
Ultrasound or CT scan for the detection of supraclavicular lymph nodes in patients with esophageal carcinoma
EPM van Vliet; A van der Lugt; EJ Kuipers; HW Tilanus; A van der Gaast; PD Siersema
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Excerpt
Malignant supraclavicular lymph nodes in patients with thoracic esophageal carcinoma are considered to be distant metastases. Both ultrasound (US) and CT scan (CT) are used to detect these metastases. It is not known whether either one or both investigations should be used to investigate the supraclavicular region. In this study, we compared US, if indicated with fine-needle aspiration (FNA), and CT for the detection of supraclavicular lymph node metastases in esophageal cancer patients. From 1994 to 2004, 567 patients with esophageal carcinoma underwent US and CT, both including the supraclavicular region, for staging of esophageal cancer. In only 108 CT reports, the radiologist explicitly mentioned the presence or absence of abnormalities in the supraclavicular region and these patients were included in this analysis. The gold standard was a radiological result with 6 months of clinical follow-up (n=69), cytological confirmation of malignancy (n=33) or post-operative detection of malignant lymph nodes in the supraclavicular region in the resected specimen (n=6).
Sensitivity of US with FNA for malignant supraclavicular lymph nodes was 74% (20/27), whereas this was 59% (16/27) for CT. Specificity was 100% (81/81) and 98% (79/81), respectively. Before performing FNA, US had classified 21 lymph node(s) as being malignant, resulting in a sensitivity of 78% (21/27) and specificity of 88% (71/81). In three patients with a positive gold standard (FNA (2), radiological result with 6 months of follow-up (1)), only CT classified supraclavicular lymph nodes as being malignant, whereas the initial US was negative. In two of these patients, a second US was positive and in one patient, the US was not repeated.
Conclusion Both US with FNA and CT of the supraclavicular region should probably be used in patients with thoracic esophageal carcinoma to detect metastases, but a blinded, comparative study is needed to confirm these results.
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