Objectives 

The objective of this pilot study was to compare the performance of contrast-enhanced EUS (CE-EUS)–guided fine-needle aspiration (FNA) with EUS-FNA for lymph node (LN) staging in esophageal cancer.

Methods 

Thirty-seven subjects with esophageal cancer undergoing EUS staging were enrolled, and 30 completed this institutional review board–approved study. A Prosound F75 US system (Hitachi Medical Systems, Tokyo, Japan) with harmonic contrast imaging software and GF-UCT180 curvilinear endoscope (Olympus, Tokyo, Japan) was utilized. All LNs identified by standard EUS were first noted. Sonazoid (dose: 1 mL; GE Healthcare, Oslo, Norway) was administered peritumorally, and all enhanced LNs were recorded. Fine-needle aspiration was performed on LNs considered suspicious by EUS alone, as well as LNs enhanced on CE-EUS. Performance of each modality was compared using FNA cytology as reference standard.

Results 

A total of 132 LNs were detected with EUS, of which 59 showed enhancement on CE-EUS. Fifty-three LNs underwent FNA, and 22 LNs were determined to be malignant. Among the latter, 10 were considered suspicious by EUS, whereas the other 12 LNs underwent FNA only because of CE-EUS enhancement. Contrast-enhanced EUS showed enhancement in 19 of the 22 malignant LNs. The rate of metastatic node identification from EUS was 45% (10/22), and it was 86% (19/22; P = 0.008) for CE-EUS. Eight subjects (8/30 [27% of study total]) had nodal status upgraded by the addition of CE-EUS, which influenced LN staging and clinical management.

Conclusions 

Fine-needle aspiration of LNs identified by CE-EUS may increase metastasis positive rate by ruling out LNs not associated with the tumor drainage pattern. In addition, CE-EUS seems to identify more metastatic LNs that would not be biopsied under the standard EUS criteria.

中文翻译：

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使用造影增强超声内镜联合瘤周注射来识别食管癌患者的前哨淋巴结

目标 

该试点研究的目的是比较对比增强 EUS (CE-EUS) 引导细针抽吸 (FNA) 与 EUS-FNA 对食管癌淋巴结 (LN) 分期的性能。

方法 

纳入了 37 名接受 EUS 分期的食管癌受试者，其中 30 名完成了机构审查委员会批准的这项研究。使用带有谐波对比成像软件的 Prosound F75 US 系统（日本东京日立医疗系统）和 GF-UCT180 曲线内窥镜（日本东京奥林巴斯）。首先记录由标准 EUS 识别的所有逻辑节点。Sonazoid（剂量：1 mL；GE Healthcare，奥斯陆，挪威）在瘤周给药，并记录所有增强的淋巴结。对仅通过 EUS 认为可疑的淋巴结以及经 CE-EUS 增强的淋巴结进行细针抽吸。使用 FNA 细胞学作为参考标准比较每种方式的性能。

结果 

EUS共检测到132个淋巴结，其中59个在CE-EUS上显示增强。53 个淋巴结接受了 FNA，其中 22 个淋巴结被确定为恶性。其中，10 例 EUS 认为可疑，而其他 12 例 LN 仅因 CE-EUS 增强而接受 FNA。增强超声内镜检查显示 22 个恶性淋巴结中有 19 个增强。EUS 的转移淋巴结识别率为 45%（10/22）， CE-EUS 的转移淋巴结识别率为 86%（19/22；P = 0.008）。八名受试者（8/30 [研究总数的 27%]）通过添加 CE-EUS 提高了淋巴结状态，这影响了 LN 分期和临床管理。

结论 

对 CE-EUS 识别的淋巴结进行细针抽吸可以排除与肿瘤引流模式无关的淋巴结，从而提高转移阳性率。此外，CE-EUS 似乎可以识别出更多根据标准 EUS 标准无法进行活检的转移性淋巴结。