Mediastinal node staging by positron emission tomographycomputed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer:Results from a regional centre

• 作者: Adrian John Stanley Chris Harrington Elisabet López González Jennifer Bisland Lyn Smith Neil Jamieson Stuart Paterson
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic ultrasound Oesophago-gastric CANCER STAGING OESOPHAGEAL CANCER POSITRON emission tomography-computed TOMOGRAPHY MEDIASTINAL nodes
• 年，卷（期）: 2018,（1）
• 页码范围: 37-44
• 页数: 8页
• 分类号: R

摘要

AIM To investigate the impact of endoscopic ultrasoundguided fine-needle aspiration(EUS-FNA)and positron emission tomography-computed tomography(PETCT)in the nodal staging of upper gastrointestinal(GI)cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015.Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included.Using a positive EUS-FNA result as the gold standard for lymph node involvement,the sensitivity,specificity,positive and negative predictive values(PPV and NPV)and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated.The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included.Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional),forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma.The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases,therefore thirteen patients(10.7%)were excluded from further analysis.There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%).The sensitivity,specificity,PPV and NPV values of PET-CT were 92.5%,50%,52.1%and 91.9%respectively.There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%).MDT discussion led to a radical treatment pathway in twenty seven of these cases,after the final tumour stage was altered as a direct consequence of the EUS-FNA findings.Of these patients,fourteen(51.9%)experienced clinical remission of a median of nine months(range three to forty two months).CONCLUSION EUS-FNA leads to altered staging of upper GI cancer,resulting in more patients receiving radical treatment t