Oncotarget

Clinical Research Papers:

Utility of endoscopic ultrasound-guided fine-needle aspiration of regional lymph nodes that are proximal to and far from the primary distal esophageal carcinoma

Yusuke Shimodaira _, Rebecca S. Slack, Kazuto Harada, Manoop S. Bhutani, Elena Elimova, Gregg A. Staerkel, Nour Sneige, Jeremy Erasmus, Hironori Shiozaki, Nikolaos Charalampakis, Venkatram Planjery, Dilsa Mizrak Kaya, Fatemeh G. Amlashi, Mariela A. Blum, Heath D. Skinner, Bruce D. Minsky, Dipen M. Maru, Wayne L. Hofstetter, Stephen G. Swisher, Jeannette E. Mares, Jane E. Rogers, Quan D. Lin, William A. Ross, Brian Weston, Jeffrey H. Lee and Jaffer A. Ajani

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Oncotarget. 2017; 8:79356-79365. https://doi.org/10.18632/oncotarget.18119

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Abstract

Yusuke Shimodaira1, Rebecca S. Slack2, Kazuto Harada1, Manoop S. Bhutani3, Elena Elimova1, Gregg A. Staerkel4, Nour Sneige5, Jeremy Erasmus6, Hironori Shiozaki1, Nikolaos Charalampakis1, Venkatram Planjery1, Dilsa Mizrak Kaya1, Fatemeh G. Amlashi1, Mariela A. Blum1, Heath D. Skinner7, Bruce D. Minsky7, Dipen M. Maru5, Wayne L. Hofstetter8, Stephen G. Swisher8, Jeannette E. Mares1, Jane E. Rogers9, Quan D. Lin1, William A. Ross3, Brian Weston3, Jeffrey H. Lee3 and Jaffer A. Ajani1

1 Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

2 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

3 Department of Gastroenterology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

4 Department of Anatomic Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

5 Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

6 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

7 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

8 Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

9 Department of Pharmacy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

Correspondence to:

Jaffer A. Ajani, email:

Keywords: esophageal carcinoma, fine-needle aspiration, endoscopic ultrasound, upper mediastinal lymph nodes, positron emission tomography

Received: March 15, 2017 Accepted: April 17, 2017 Published: May 23, 2017

Abstract

Implications of assessing the proximal and far para-tracheal or sub-carinal nodes (para-tracheal [PTN] or sub-carinal [SCN]) associated with lower primary esophageal carcinomas (ECs) are unclear. To evaluate the value of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) for PTN and SCN, we analyzed results by positron emission tomography (PET) avidity, 4 EUS node malignancy features, and EUS-FNA results in all patients with Siewert’s I or II EC. Of 133 patients (PTN, n=102; SCN, n=31) with EUS-FNA, 47 (35%) patients had malignant node, leading to treatment modifications. EUS-FNA diagnosed significantly more patients with malignant nodes (p=0.02) even when PET and EUS features were combined. Among 94 PET-negative and EUS-negative patients, 9 (10%) had malignant EUS-FNA. At a minimum follow-up of 1 year, only 3 (5%) of 62 patients with benign EUS-FNA had evidence of malignancy in the nodal area of prior EUS-FNA. Patients with malignant EUS-FNA independently had a much shorter overall survival (OS) than those with benign EUS-FNA (p<0.001). Our data suggest that a benign EUS-FNA is highly accurate and need not be pursued further. However, malignant EUS-FNA of PTN/SCN was independently prognostic, conferred a shorter OS, and altered the management of 35% of patients.


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