Accuracy of EUS-FNA for distant regional lymph nodes in the initial staging of esophageal cancer (EC).

4064 Background: Accurate clinical staging is essential for making immediate treatment decisions. The role of endoscopic ultrasound (EUS) and fine needle aspiration (FNA) in altering treatment has been debated in patients diagnosed with cStage II or III EC. The purpose of this study was to assess the yield of EUS-FNA for paratracheal and subcarinal lymph nodes in distal ECs. Methods: We analyzed278 EC patients who had baseline EUS-FNA between 2010 and 2014. A subgroup of 85 patients with Seiwert’s type I or II EC had FNAs of the paratracheal or subcarinal nodes (far away from the primary EC) were carefully reviewed. The accuracy of EUS, PET, EUS+PET, and FNA were compared using FNA as the gold standard. A McNemar’s test was used to determine whether EUS+PET or FNA performed differently in identifying positive nodes. Results: In the subgroup of 85 patients, FNA was positive for malignancy in 27 (32%) leading to modifications of the radiation field in upper thorax. Moreover, EUS, PET, and EUS+PET had an acc...