Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2025
Clinical significance and efficacy of endoscopic ultrasound-guided tissue acquisition for para-aortic lymph node metastasis.
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Hara Hidenobu, Hijioka Susumu, Yamashige Daiki, Nagashio Yoshikuni, Komori Yasuhiro, Kuwada Masaru, Fukuda Soma, Yagi Shin, Okamoto Kohei, Agarie Daiki, Chatto Mark, Okada Mao, Maruki Yuta, Morizane Chigusa, Ueno Hideki, Saito Yutaka, Yonemori Kan, Okusaka Takuji
Аннотация
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.
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.