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The significance of pre-operative diagnosis of esophageal cancer using esophageal mediastinal ultrasonography.

Esophageal ultrasonography (EUS) is a new diagnostic method which allows improved preoperative diagnosis of esophageal cancer. Careful examination of EUS findings and comparison of these findings with operative and pathological findings yielded criteria useful for the determination of tumor depth and lymphnode metastasis. Concerning tumor depth, EUS findings of 30 patients were reviewed and compared with operative and pathological findings. Based on this comparison some diagnostic criteria were then chosen; it was found that the accuracy was around 87% and that the differentiation between intramural and extraluminar invasion could be easily made using these criteria. Regarding the lymphnodes, at the time of operation, the site and size of each lymphnode (a total of 267 nodes) were recorded. These findings were grouped according to the site and size. We found the range of sizes of metastatic lymphnodes to be great and not so different from that of normal nodes. We then compared these anatomical findings with the EUS findings in an attempt to determine appropriate diagnostic criteria, which would include size as well as intrinsic and extrinsic echocharacteristics. When these criteria were used, the accuracy was about 90%. Although this preliminary study must be confirmed by further prospective studies with a large number of patients, we can conclude that EUS allows accurate determination of tumor depth and node metastasis in patients with esophageal cancer.