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Ann Thorac Surg 2002;73:920-921
© 2002 The Society of Thoracic Surgeons

Invited commentary

James D. Luketich, MDa

a Division of Thoracic Surgery, University of Pittsburgh Medical Center, C-800 Presbyterian University Hospital, 200 Lothrop St, Pittsburgh, PA 15213-3221, USA

e-mail: luketichjd{at}msx.upmc.edu

The authors are to be congratulated on this manuscript, which illustrates the successful clinical application of advances in endoscopic ultrasound (EUS) technology that allows fine needle aspiration (FNA) of celiac lymph nodes in selected patients with esophageal cancer. Importantly, the authors point out the limitations of current imaging techniques available for staging esophageal cancer and how inaccuracies in conventional imaging may negatively impact on therapeutic decisions.

Further advances will need to be achieved before routine application of EUS-FNA is clinically available for staging patients with esophageal cancer. Current problems include limited access to lymph node stations outside of the celiac region, technical difficulty of FNA-guided aspiration of lymph nodes less than one centimeter and the limited availability of endoscopists skilled in this technique. Advances in molecular diagnostics continue to be made and will require continued investigation of their application to FNA specimens. The routine availability of accurate staging of patients with esophageal cancer should allow us to better assess response to new therapies.


Related Article

Clinical impact of endoscopic ultrasound-guided fine needle aspiration of celiac axis lymph nodes (M1a disease) in esophageal cancer
Kiran S. Parmar, Joseph B. Zwischenberger, Angela L. Reeves, and Irving Waxman
Ann. Thorac. Surg. 2002 73: 916-920. [Abstract] [Full Text] [PDF]




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