(Ultrasound Review) Japanese surgeons investigated a series of patients with esophageal carcinoma, who underwent ultrasound examinations including an endoscopic approach, in order to analyze the impact on prognosis of the number of lymph node metastases detected.
"Developments in imaging techniques, especially in ultrasonography and endoscopic ultrasonography, have improved the presurgical diagnosis of lymph node metastasis in gastrointestinal tumors,: according to the authors. The results of their study were published in Annals of Surgery.
Over a ten-year period, the results of 329 consecutive patients with esophageal carcinoma who had esophagectomy with lymphadenectomy, as well as preoperative ultrasound examination for lymph node metastases were analyzed. Either a 3.75 MHz or 5 MHz transducer was used for examining the abdominal and cervical regions. Details of the endoscopic ultrasound technique were not well described by the authors. They specify the endoscopic transducer as a 7.5 MHz linear array, however it would have to be assumed that they used a sector transoesophageal transducer, commonly used for cardiac examinations. This method was used to examine the mediastinal region.
For both techniques, the ultrasound vascular landmarks such as the aorta, the celiac axis and the carotid arteries were easily identified and used for locating lymph nodes. Three ultrasound classifications were used for evaluating lymph nodes. Normal lymph nodes had poorly defined boundaries and diffuse homogeneous internal echoes, while metastatic nodes had well-defined boundaries with either weak and relatively sonolucent internal echoes or demonstrated notching and strong internal echoes.
Results demonstrated that the accuracy of ultrasound detection was over 70% in each category of TNM classification. The preoperative incidence of lymph node metastasis was 69%, while the histologic diagnosis was 59.3%, resulting in a significant correlation. Five-year survival rates were calculated for subgroups using both preoperative and histologic diagnosis and the survival curves were comparable. The 5-year survival rates for patients using preoperative ultrasound detection were: no metastatic lymph nodes 53.3%; one to three lymph nodes 33.8%; four to seven lymph nodes 17% and eight or more lymph nodes 0%.
"Not only the stage grouping of TNM classification but also the number of lymph node metastases determined by ultrasound and endoscopic ultrasound before surgery may be useful for predicting prognosis in patients with esophageal carcinoma," they concluded.
"Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma"S Natsugoe et al
First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
Annals of Surgery 2001(December); 234:613-618
By Ultrasound Review
January 7, 2002
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
