Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy

Article Abstract:

The prognosis for patients with cancer of the esophagus (between the throat and stomach) and the gastroesophageal junction (where the esophagus and stomach meet) is highly variable, but usually much more favorable when the cancer has not spread to the lymph nodes. It is important to know if the lymph nodes are involved prior to surgery to decide upon proper treatment and to predict the patient's prognosis. Mediastinal (chest area) and abdominal lymph nodes have been examined using computed tomography (CT). Cancerous supraclavicular lymph nodes (above the collar bone) can sometimes be palpated or felt with the fingers, but this method is not reliable. Using computed tomography (CT) and ultrasound (US) to examine these lymph nodes for the spread of cancer has not been systematically studied. CT and US are noninvasive imaging techniques, the former being computer generated images from X-ray scanning and the latter being images produced by the use of high-frequency sound waves. This study compared supraclavicular lymph node examination by palpation with CT, US, and US-guided fine-needle aspiration biopsy (FNAB) in 100 patients diagnosed with cancer of the esophagus. All patients were examined by palpation, CT (except for 10 patients), and US. When abnormal nodes were detected the patients underwent US-guided FNAB. Abnormal nodes were detected in 26 patients; 22 cases (of 100) were detected by US, and 15 cases (of 90) were detected by CT. All abnormal nodes were detected by US or CT, with many detected by both. In 23 cases, US-guided FNAB revealed that 16 patients had cancerous lymph nodes. The cancerous nodes were round in appearance and more likely to be found when the esophageal cancer was squamous cell carcinoma than when it was adenocarcinoma. Abdominal and mediastinal nodes appeared to be normal in 4 of the 16 cases with cancerous supraclavicular nodes. These results indicate that, in patients with esophageal cancer, examination of supraclavicular lymph nodes should not be limited to palpation and should include US examination as well as CT examination if the US results are negative. US-guided FNAB can be used to confirm the presence of cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasound imaging, Esophageal cancer, Diagnostic imaging, Biopsy, Needle, Needle biopsy, Lymphatic metastasis

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Use of CT for predicting gallstone composition: a dissenting view

Article Abstract:

Determination of the composition of gallstones is important in choosing the proper treatment. Gallstones that are mainly composed of cholesterol can often be removed by nonsurgical techniques, while highly calcified stones usually require surgical removal. Computed tomography (CT), a scanning X-ray technique that generates computer images, has been used to determine the composition of gallstones. CT is very sensitive in detecting small amounts of calcification in gallstones. However, regular X-rays can detect gallstones and calcification of them in many cases. CT is mainly useful in detecting and characterizing radiolucent pigment stones. CT cannot always detect these stones, and the result is that CT is useful in characterizing stones in about 10 percent of cases. This characterization can differentiate between stones that are mainly cholesterol and stones that are mainly pigment. However, both types of stones can be highly calcified, and such calcification can be detected by regular X-rays. Oral cholecystography (OCG) can be used to analyze stone number, size, and surface features. It is just as accurate in characterizing stones as is CT. Thus, CT can be sensitive and accurate in characterizing some aspects of gallstones. However, it can be a costly and cumbersome procedure that provides little useful information beyond regular X-rays for determining the proper treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Predicting gallstone composition with CT: in vivo and in vitro analysis

Article Abstract:

Gallstones can either be removed surgically or dissolved with a laser while still in the gallbladder, after which the body flushes out the dissolved particles. Nonsurgical treatment is preferable, but not all patients respond to laser treatment. One major determinant of which treatment to use is the composition of the gallstones. Stones with a high cholesterol and low calcium content respond best to laser treatment. This study examined the usefulness of computed tomography (CT) in evaluating gallstone composition. CT is an imaging technique that uses a computer to generate images from data obtained from scanning X-rays. Results from CT, abdominal X-rays, and X-rays of the gallbladder after oral administration of a contrast agent (cholecystography, OCG) were compared with chemical analysis of gallstones removed from 50 patients. The chemically analyzed stones were grouped by cholesterol content. CT attenuation values, a measurement of the loss of energy through the stones, were compared with the chemically derived groups. There was a good correlation between the CT values and the cholesterol and calcium content of the stones. CT was more accurate in determining stone content than either X-rays or OCG. These results indicate that CT can be very useful in predicting gallstone composition and, thus, choosing the proper treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diseases

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