The use of ultrasound combined with ultrasound-guided fine-needle aspiration biopsy (UGFAB) of supraclavicular lymph nodes in the pretreatment staging of 37 patients with squamous cell carcinoma of the esophagus is described. All patients underwent computed tomography (CT) scans of the chest and the abdomen and ultrasound of the abdomen and supraclavicular regions. Supraclavicular lymph node metastases (Stage IV disease according to the tumor nodes metastasis [TNM] classification) were cytologically diagnosed in seven (18.9%) of the 37 patients. In two of these patients, no other metastases were found. In the other five patients, UGFAB replaced more invasive diagnostic procedures. Due to their superficial location, ultrasound and UGFAB of the supraclavicular lymph nodes was relatively simple to perform, and contributed to an improved staging of squamous cell carcinoma of the esophagus. Cancer 67:585-587,1991. ARCINOMA OF THE esophagus has a poor prognosis.
C Due to the advanced stage of disease frequently present at the time of diagnosis, survival rates remain low. Surgical treatment is generally associated with a high postoperative morbidity and mortality and does not seem justified in patients with distant meta~tases.'-~ Therefore, accurate pretreatment staging is of great importance to select the subgroup of patients who can benefit from an operation.
CT of the chest and abdomen is generally accepted as the single most accurate noninvasive study for the pretreatment staging of carcinoma of the esophag~s.~ Some authors claim that CT is accurate in demonstrating local invasion of the although opposing opinions have been r e p ~r t e d . ~, ~ CT, however, is not a sensitive predictor of metastatic involvement of periesophageal lymph nodes6T8-I0 and also seems limited in its ability to detect involvement of abdominal nodal areas.8-' Patients are