ENDOSCOPIC ULTRASOUND FOR THE IDENTIFICATION OF LOCOREGIONAL LYMPH-NODE METASTASES OF GASTROINTESTINAL TUMORS

The locoregional lymph node status was assessed via EUS and CT in 118 patients (37 female, 81 male, average age 63.1 [37-87] years) who had histologically confirmed neoplasias in the upper GI tract. These investigations were made as part of preoperative tumour staging. Resections were performed subsequently, yielding regional lymph node metastases in 76 cases and in 23 patients only enlarged lymph nodes with benign histological findings. Overall accuracy of findings of regional lymph node metastases was 84% for oesophageal carcinomas with EUS and 57% with CT, 78% for gastric carcinomas with EUS and 46% with CT and 68% for pancreatic and ampullary carcinomas with EUS and 53% with CT. In 2 non-Hodgkin lymphomas of the stomach, paragastral malignant lymphomas were identified via EUS but not via CT. In two further cases both methods yielded false positive results. Locoregionally enlarged lymph nodes with exclusively benign histology were found in 22 of 23 cases via EUS but were misinterpreted as metastases in 15 cases. Hence, EUS is evidently superior to CT in identifying locoregional lymph node metastases. The accuracy, however, does not represent tumour status assessment made possible with the help of endosonographic criteria; rather, it is essentially due to the high degree of sensitivity of the method and the scarcity of completely benign enlargements of lymph nodes in the vicinity of neoplasias.