| Background and ObjectiveEsophageal cancer is one of the most frequent malignant tumors in China.The incidence rate is the fifth in all malignant tumors.The mortality rate is the fourth place after lung cancer,gastric cancer and liver cancer.The total survival rate of 5 years is about 15%~34%.Lymph node metastasis is the most important transfer mode of esophageal cancer.It is also one of the most important factors affecting the prognosis.It is reported that cervical lymph node metastasis has occurred about 20%~40% in patients with esophageal cancer before operation.It is generally believed that a reasonable range of lymph node dissection can achieve the purpose of radical surgery on the one hand,on the other hand,it can improve the quality of life of patients,and more importantly,it can reduce the incidence of postoperative complications.Therefore,selective three-field lymph node dissection for patients with esophageal cancer has become a hot spot in recent years.Our country has not taken radical resection of three-field lymph node dissection for esophageal cancer as the standard operation for esophageal cancer.Although many clinical studies have shown that the three-field lymph node dissection in patients with esophageal cancer can reduce the recurrence rate of the lymph nodes and prolong the survival of the patients.However,the incidence of complications such as recurrent laryngeal nerve injury,postoperative pulmonary infections,chylothoraxes and the decline of quality of life after operation caused by three-field lymph node dissection offset the long-term advantages of three-field lymph node dissection.Therefore,how to accurately perform selective three-field lymph node dissection on esophageal cancer patients is the key means to resolve this contradiction.Color Doppler ultrasound and MRI are the main imaging methods for detecting cervical lymph node metastasis in patients with esophageal cancer.However,there are many crossover between benign lymph nodes and malignant lymph nodes.These detection methods can only provide clues for diagnosis,and there are false positive and false negative results based on imaging diagnosis.In this article,ultrasound-guided biopsy is used to combine the high sensitivity of ultrasound with the high specificity of cytology,aims to increase the detection rate of metastatic cervical lymph nodes in patients with esophageal cancer,and to reduce the false positive and false negative caused by pure color Doppler ultrasound diagnosis results.Provide more accurate evidence for the choice of individualized treatment options for patients with esophageal cancer MethodWe retrospectively analyzed 85 patients with esophageal cancer who were admitted to the Department of Thoracic Surgery,Cancer Hospital Affiliated to Zhengzhou University from May 2017 to December 2017.All patients underwent color Doppler ultrasonography when they first entered the hospital.The findings all indicated abnormal lymph nodes in the neck,and all of them underwent color Doppler ultrasonography guided lymph node biopsy.The pathological findings of the puncture suggested that patients with cervical lymph node metastasis underwent minimally invasive esophagectomy plus three-field lymph node dissection,and those with negative puncture pathological findings underwent minimally invasive esophagectomy plus two-field lymph node dissection.The clinical and pathological data of two groups of patients were recorded in detail.The diagnosis of cervical abnormal lymph nodes and the pathological results of abnormal lymph nodes guided by color Doppler ultrasound were compared with color Doppler ultrasound.At the same time,the incidence of perioperative complications was compared between the two groups.The ?~2 test wasused for categorical data,and the Fisher's exact test was used when the expected values in any of the cells of a contingency table were less than 5.The t-test was used for continuous data with normal distributions,and in cases of a non-normal data distribution,the Mann–Whitney U-test was used.Statistical analyses were performed using SPSS version 25.0(SPSS Inc.,Chicago,IL,USA),and the P-values ?0.05 were considered statistically significant.ResultsAmong the 85 patients,129 abnormal lymph nodes were found in the neck by color Doppler ultrasound.The number of metastatic lymph nodes suggested by Color Doppler Ultrasound was 62.Contrast to color Doppler guided lymph node biopsy,41 of them were positive and 21 were false positive.Color Doppler Ultrasound revealed that the number of negative lymph nodes in the cervical region was 67.Similarly,compared with the puncture pathological findings,52 were true negative and 15 were false negative.The sensitivity,specificity and accuracy of color Doppler ultrasound in the diagnosis of cervical lymph node metastasis were 73.2%,71.2%,and 72.1%,respectively.Color Doppler ultrasonography revealed 35 cases of cervical lymph node metastases,of which 8 patients underwent color Doppler ultrasound guided biopsy pathology to confirm no metastasis of cervical lymph nodes.This group of patients avoided three-field lymph node dissection and reduced surgical trauma.Color Doppler sonography showed that there were 50 patients with cervical lymph node negative,of which 9 patients underwent color Doppler guided biopsy pathology to confirm cervical lymph node metastasis.These patients promptly took three-field lymph node dissections to benefit their prognosis.There was no significant difference in the incidence of major complications such as postoperative anastomotic leakage,pneumonia,recurrent laryngeal nerve injury,and chylothorax.ConclusionsColor Doppler-guided cervical lymph node biopsy improves the detection rate of metastatic lymph nodes in patients with esophageal cancer,providing a more accurate basis for individualized and rational treatment of patients with esophageal cancer. |
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