Clinical significance and efficacy of endoscopic ultrasound-guided tissue acquisition for para-aortic lymph node metastasis

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2025-03-10 DOI:10.1111/den.15009

Hidenobu Hara, Susumu Hijioka, Daiki Yamashige, Yoshikuni Nagashio, Yasuhiro Komori, Masaru Kuwada, Soma Fukuda, Shin Yagi, Kohei Okamoto, Daiki Agarie, Mark Chatto, Mao Okada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Kan Yonemori, Takuji Okusaka

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引用次数: 0

Abstract

Objectives

Assessing para-aortic lymph node (PALN) metastasis in solid tumors is crucial for accurate staging. In clinical practice, PALN metastasis is typically diagnosed based on imaging findings; however, the efficacy of endoscopic ultrasound-guided tissue acquisition (EUS-TA) in diagnosing PALN metastasis remains insufficiently understood.

Methods

This single-center, retrospective study included patients who underwent EUS-TA of PALNs and computed tomography (CT). Final diagnoses were based on pathological findings or 12-month imaging follow-up.

Results

Among 167 patients, technical success was achieved in 162 (97.0%). EUS-TA demonstrated a sensitivity, specificity, and accuracy of 85.1% (63/74), 100% (88/88), and 93.2% (151/162), respectively, for PALN metastasis. These results showed significantly higher sensitivity (28.4% vs. 85.1%, P < 0.001) and accuracy (64.8% vs. 93.2%, P < 0.001) than those of CT. The accuracy of CT and EUS-TA was 86.8% vs. 89.5% for PALNs measuring <5 mm, 51.5% vs. 92.9% for those measuring 5–10 mm, and 84.0% vs. 96.0% for those measuring ≥10 mm, with a significant difference in the 5–10 mm category (P < 0.001). Among the 44 patients diagnosed with resectable pancreatic cancer using CT, the final diagnosis confirmed PALN metastasis in 10 (22.7%) patients, and EUS-TA preoperatively identified PALN metastasis in eight (18.2%) patients. EUS-TA significantly reduced unnecessary surgeries compared with CT-only diagnoses (P = 0.013).

Conclusion

Endoscopic ultrasound-guided tissue acquisition of PALNs offers high diagnostic accuracy and can detect PALN metastasis often missed by CT alone. Integrating EUS-TA into preoperative assessments has the potential to substantially reduce unnecessary surgeries, improve patient outcomes, and plan treatment strategies.

Abstract Image

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超声内镜引导下组织采集治疗主动脉旁淋巴结转移的临床意义及疗效。

目的：评估实体瘤的腹主动脉旁淋巴结（PALN）转移对准确分期至关重要。在临床实践中，PALN转移的诊断通常基于影像学表现；然而，内镜超声引导下的组织采集（EUS-TA）在诊断PALN转移中的作用仍然不够清楚。方法：这项单中心、回顾性研究纳入了接受EUS-TA检查和计算机断层扫描（CT）的paln患者。最终诊断基于病理结果或12个月的影像学随访。结果：167例患者中，162例（97.0%）技术成功。EUS-TA对PALN转移的敏感性、特异性和准确性分别为85.1%（63/74）、100%（88/88）和93.2%（151/162）。结论：超声引导下的PALN组织采集具有较高的诊断准确性，可以发现单纯CT无法发现的PALN转移。将EUS-TA纳入术前评估有可能大大减少不必要的手术，改善患者预后，并制定治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.