Endobronchial Ultrasound Improves Evaluation of Recurrent Laryngeal Nerve Lymph Nodes in Esophageal Squamous Cell Carcin
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Endobronchial Ultrasound Improves Evaluation of Recurrent Laryngeal Nerve Lymph Nodes in Esophageal Squamous Cell Carcinoma Patients Xiayu Fu1,2,5, Feixiang Wang3,5, Xiaodong Su2,5, Guangyu Luo4,5, Peng Lin2,5, Tiehua Rong2,5, Guoliang Xu4,5, Rong Zhang4,5, Xinye Wang2,5, Yaobin Lin2,5, Jianhua Fu2,5, and Xu Zhang2,5 1
Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Thoracic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China; 3Department of Thoracic Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China; 4Department of Endoscopy, Sun Yat-sen University Cancer Centre, Guangzhou, China; 5Guangdong Esophageal Cancer Institute, Collaborative Innovation Centre of Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
2
ABSTRACT Background. The bilateral recurrent laryngeal nerve (RLN) lymph nodes are the most common metastatic site for esophageal squamous cell carcinoma (ESCC); however, the RLNs are susceptible to injury during dissection. Clinically, there is an urgent need to determine an effective diagnostic method for RLN nodes to help achieve selective nodal dissection and avoid potential serious complications by performing more conservative surgery for those with nonmetastatic nodes. Here, we innovatively applied endobronchial ultrasonography (EBUS) and investigated its diagnostic performance for preoperative evaluation of RLN nodes in ESCC patients. Patients and Methods. All 81 enrolled ESCC patients underwent preoperative EBUS and CT examinations. The ability of EBUS and CT to detect RLN node metastasis was evaluated based on the resulting sensitivity, specificity,
Xiayu Fu, Feixiang Wang, Xiaodong Su and Guangyu Luo have contributed equally to this work. Ó Society of Surgical Oncology 2020 First Received: 7 June 2020 Accepted: 28 September 2020 J. Fu e-mail: [email protected] X. Zhang e-mail: [email protected]
accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results. The diagnostic performance of EBUS was superior to that of CT; in particular, EBUS of the left RLN (LRLN) nodes presented the best sensitivity, specificity, PPV, NPV, and accuracy compared with EBUS evaluations of the right RLN (R-RLN) nodes, CT of the L-RLN and R-RLN nodes. Moreover, EBUS combined with CT increased the NPV relative to that of EBUS or CT alone, promoting the ability to identify true-negative RLN nodes. In particular, the NPVs of the combined modality were 100% for both the L- and R-RLN nodes in early-T-stage (T1–T2) ESCC. Conclusions. EBUS is an efficient tool for RLN node evaluation, and the combination with CT may provide better guidance for selective RLN node dissection in ESCC patients.
Esophageal squamous cell carcinoma (ESCC) is one of the most lethal malignancies in China,1 with a majority of patients already presenting an advanced tumor stage at time of diagnosis.2 Radical surgery compri
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