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：Chris Harrington Lyn Smith Jennifer Bisland Elisabet López González Neil Jamieson Stuart Paterson Adrian John Stanley 

作者机构：Glasgow Royal InfirmaryGlasgow G4 0ETUnited Kingdom Forth Valley Royal HospitalLarbert FK5 4WRUnited Kingdom Raigmore HospitalInverness IV2 3UJUnited Kingdom Hospital Vega BajaOrihuela 03314Spain 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2018年第10卷第1期

页      面：37-44页

学科分类：10[医学] 

主　　题：Endoscopic ultrasound Oesophago-gastric cancer staging Oesophageal cancer Positron emission tomography-computed tomography Mediastinal nodes 

摘      要：AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral *** 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 *** 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 sta