Computer-assisted analysis of lymph nodes detected by EUS in patients with esophageal carcinoma.

Background: EUS determination of lymph nodal spread of intestinal cancer based on imaging alone is problematic. A noninvasive, reliable means of determining tumor spread to lymph nodes is desirable. This study investigated the feasibility of a computer-assisted evaluation of lymph nodes detected by EUS in patients with esophageal carcinoma.

Methods: Images were obtained during EUS of esophageal lesions and correlated with histopathologic findings after esophagectomy. Sonographic features of echogenicity, whole-node heterogeneity, and regional variability were assessed by computerized image analysis in patients with benign versus malignant lymphadenopathy.

Results: Malignant lymph nodes were hypoechoic compared with benign lymph nodes (p < 0.04). Whole lymph node heterogeneity was increased in malignant lymph nodes (p < 0.004). Regional variability was greater for benign lymph nodes.

Conclusions: These data support the feasibility of a computer-assisted system for analysis of lymph node metastasis in patients with esophageal carcinoma. Further refinements of such a system could increase the accuracy of EUS staging of tumors.