Surg Endose tumor with PET In addition PeT may not detect 4.Pfau PR.Perlman SB Sta o P.Frick TJ.Gopal DV.Said A microscopic metastasis of lymph nodes due to its limited resolution effects. In a metaanalysis of the EUS.PET,and CT results for not perfo d and nostic accuracy for N staging did not differ significantly and was in lin e with our results. o E1.Knuuti MJ.Minn HR.Luostarinen ME Regarding the relati vely ow accuracy and sensitivity of stagi EUS-gu dne-needle aspira- method.T use of EUS-FNA preope bo sensitivity and accuracy for the detection of nonperitu- moral lymph node metastases [23].However,lymph nodes Med cause the need would have to traverse 0 This 46 ymp e可A (2002)AJCC Our data are limited by the inclusion of patients with a 11.Dw somewhat narrowed clinical spectrum of disease because 12 330 only surgically re sectable patients were enrolled in this opic u our study shows good diag racy for EUS T staging of esophageal cancer.and our ol14:1479-1490 findings show that the diagnostic accuracy of N staging by Rosch T US is fore,EUS could ncer.esp 15.wa lace MB.Hawes RH.Sahai AV.Van Velse A.Hoffman B 16.Van Dam J.Rice TW.Catalano MF.Kirby T.Sivak MV References 17.Pfaw PR.C nt 1.Mayer RJ(0)cancer. l95281285 18.E ve VI B aE.Fletcher JG.Nathan M.Jensen E.Mullan B Allen MS.Levy M.)Compa d EU on o meta ancern-center 场一的 3 Dullemen HM,van der Jag 2 e na combined Springermetaanalysis [13]. Not surprisingly, lymph nodes adjacent to the primary tumor are difficult to differentiate from the primary tumor with PET. In addition, PET may not detect microscopic metastasis of lymph nodes due to its limited resolution effects. In a metaanalysis of the EUS, PET, and CT results for esophageal cancer staging, the pooled sensitivities for N stage were 0.80 for EUS, 0.57 for PET, and 0.50 for CT, although these three methods were not performed and analyzed concomitantly [22]. However, the overall diag￾nostic accuracy for N staging did not differ significantly and was in line with our results. Regarding the relatively low accuracy and sensitivity of these tests for N staging, EUS-guided fine-needle aspira￾tion (EUS-FNA) may be considered for preoperative staging method. The use of EUS-FNA increases both sensitivity and accuracy for the detection of nonperitu￾moral lymph node metastases [23]. However, lymph nodes at the level of the primary tumor often are not accessible to EUS-FNA because the needle would have to traverse the tumor to obtain a specimen. This carries the potential risk of cancer cells spreading into lymph nodes that may not be malignant. Our data are limited by the inclusion of patients with a somewhat narrowed clinical spectrum of disease because only surgically resectable patients were enrolled in this study. Patients with advanced disease stages were exclu￾ded, which may be related to underestimation of both sensitivity and accuracy in the detection of metastasis to lymph nodes. In conclusion, our study shows good diagnostic accu￾racy for EUS T staging of esophageal cancer, and our findings show that the diagnostic accuracy of N staging by EUS is as good as that of PET or CT. Therefore, EUS could be useful for determining a therapeutic strategy for esophageal cancer, especially for resectable diseases. 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