Endoscopic ultrasound-guided fine-needle aspiration is the most accurate method for lymph-node staging of esophageal carcinoma.
However, it may not be necessary when endoscopic ultrasound features are present that strongly suggest a benign or a malignant origin.
Dr Enrique Vazquez-Sequeiros and colleagues from Minnesota identified endoscopic ultrasound criteria that have sensitivity and specificity to preclude the need for endoscopic ultrasound-guided fine-needle aspiration.
The research team also assessed the cost savings derived from a selective endoscopic ultrasound-guided fine-needle aspiration approach.
A total of 144 patients with esophageal carcinoma were prospectively evaluated with endoscopic ultrasound.
The team compared accuracy of standard, and modified criteria using 2 diagnostic strategies.
|Endoscopic ultrasound selective approach may avoid performing fine-needle aspiration in 42%|
The researchers assessed all patients with lymph nodes in the routine strategy.
Endoscopic ultrasound-guided fine-needle aspiration was only used where the number of endoscopic ultrasound malignant criteria provided a sensitivity and a specificity less than 100%.
Modified endoscopic ultrasound criteria for lymph-node staging were more accurate than standard criteria.
The team noted that no criterion alone was predictive of malignancy.
Sensitivity and specificity reached 100% when a cutoff value of more than 1, or more than 6 modified criteria were used, respectively.
The endoscopic ultrasound-guided fine-needle aspiration selective approach may avoid performing fine-needle aspiration in 42% of patients.
Dr Vazquez-Sequeiros' team commented, “Modified endoscopic ultrasound lymph-node criteria are more accurate than standard criteria.”
“A selective endoscopic ultrasound-guided fine-needle aspiration approach reduced the cost by avoiding endoscopic ultrasound-guided fine-needle aspiration in 42% of patients with esophageal carcinoma.”
“These results require confirmation in future studies.”