Background and study aims: Accurate lymph node staging is essential for the selection of an optimal treatment
in patients with upper gastrointestinal cancer. Endoscopic ultrasound (EUS) and fine-needle
aspiration (FNA) are considered to be the most accurate method for locoregional staging.
Endoscopic sonoelastography (ESE) assesses the elasticity of lymph nodes and has been
used to differentiate lymph nodes with promising results. The aim of this study was
to evaluate the use of EUS, EUS – FNA, ESE, and ESE-strain ratio using histology as
the gold standard.
Patients and methods: Patients with upper gastrointestinal cancer who were referred for EUS examination
were enrolled if surgical treatment was planned and the patient had a lymph node that
was accessible for EUS – FNA and EUS-guided fine-needle marking (FNM). The lymph node
was classified using EUS, ESE, and ESE-strain ratio. Finally, EUS – FNA and EUS – FNM
were performed. The marked lymph node was isolated during surgery for histological
examination.
Results: The marked lymph node was isolated for separate histological examination in 56 patients,
of whom 22 (39 %) had malignant lymph nodes and 34 (61 %) had benign lymph nodes.
There were no complications of EUS – FNM. The sensitivity of EUS for differentiation
between malignant and benign lymph nodes was 86 % compared with 55 % – 59 % for the
different ESE modalities. The specificity of EUS was 71 % compared with 82 % – 85 %
using ESE modalities.
Conclusion: The use of the EUS – FNM technique enabled the identification of a specific lymph
node and thereby the use of histology as gold standard. ESE and ESE-strain ratio were
no better than standard EUS in differentiating between malignant and benign lymph
nodes in patients with resectable upper gastrointestinal cancer.
