{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T22:49:32Z","timestamp":1769208572252,"version":"3.49.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,9]]},"abstract":"<jats:title>SUMMARY<\/jats:title>\n                  <jats:p>In Western Europe, esophageal cancer patients with cervical lymph node metastases are considered to have stage IV disease and are generally not eligible for curative treatment. While cervical ultrasound was part of standard diagnostic workup, its added value after negative 18FDG PET-CT is debated, and ultrasound is no longer in the Dutch guideline as standard workup modality. This study assessed the diagnostic accuracy of ultrasound for the detection of cervical lymph node metastases in esophageal cancer patients. This retrospective cohort study included all esophageal cancer patients referred to or diagnosed at the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed to identify patients with suspicious cervical lymph node(s). Primary outcome was the detection rate of cervical lymph node metastases on ultrasound and\/or 18FDG PET-CT. The gold standard was fine needle aspiration. This study included 747 patients; median age was 67\u00a0years. Patients were predominantly male (75.5%) and majority had an adenocarcinoma (72.0%). Total of 112 (15.0%) patients had suspicious cervical lymph nodes, with malignancy confirmed in 38 cases. Cervical ultrasound showed high sensitivity (94.7%), but low positive predictive value (37.1%) compared to 18FDG PET-CT, which had 100% sensitivity, 91.3% specificity, and 71.7% PPV. This study demonstrated that cervical ultrasound offers no additional diagnostic value over 18FDG PET-CT alone in the assessment of cervical lymph node metastases during diagnostic workup for esophageal cancer and increases the number of fine needle aspirations conducted for benign cervical lymph nodes.<\/jats:p>","DOI":"10.1093\/dote\/doaf135","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T12:37:03Z","timestamp":1768048623000},"source":"Crossref","is-referenced-by-count":0,"title":["Additional diagnostic value of cervical ultrasound in the detection of cervical lymph node metastases in patients with esophageal cancer"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9184-2312","authenticated-orcid":false,"given":"Jasmijn R","family":"van Doesburg","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism Research Institute , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nannet","family":"Schuring","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark H M","family":"Vries","sequence":"additional","affiliation":[{"name":"Department of Radiology, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pim","family":"de Graaf","sequence":"additional","affiliation":[{"name":"Department of Radiology, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katya M","family":"Duvivier","sequence":"additional","affiliation":[{"name":"Department of Radiology, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freek","family":"Daams","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location Vrije Universiteit , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8689-3134","authenticated-orcid":false,"given":"Mark I","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism Research Institute , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9655-7601","authenticated-orcid":false,"given":"Suzanne S","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam, Noord-Holland ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"issue":"9","key":"2026012209533760900_ref1","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1016\/S1470-2045(15)00040-6","article-title":"Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial","volume":"16","author":"Shapiro","year":"2015","journal-title":"Lancet Oncol"},{"key":"2026012209533760900_ref2","volume-title":"TNM classification of malignant tumours","author":"Sobin","year":"2011"},{"key":"2026012209533760900_ref3","volume-title":"AJCC cancer staging manual","author":"Amin","year":"2018","edition":"8th"},{"key":"2026012209533760900_ref4","volume-title":"Landelijke richtlijn: Oesofaguscarcinoom, vol. Versie 3.1","author":"Integraal Kankercentrum Nederland (IKNL)"},{"key":"2026012209533760900_ref5","author":"Nederlandse Vereniging van Maag-Darm-Leverartsen","year":"2015"},{"issue":"7","key":"2026012209533760900_ref6","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1097\/MNM.0000000000000847","article-title":"Limited additional value of cervical ultrasonography over a negative 18F-FDG PET\/CT for diagnosing cervical lymph node metastases in patients with esophageal cancer: a systematic review and meta-analysis","volume":"39","author":"Goense","year":"2018","journal-title":"Nucl Med Commun"},{"issue":"5","key":"2026012209533760900_ref7","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1007\/s00330-017-5136-x","article-title":"Cervical ultrasonography has no additional value over negative 18F-FDG PET\/CT scans for diagnosing cervical lymph node metastases in patients with oesophageal cancer","volume":"28","author":"Goense","year":"2018","journal-title":"Eur Radiol"},{"issue":"2","key":"2026012209533760900_ref8","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jtcvs.2019.11.046","article-title":"Does [18F] fluorodeoxyglucose\u2013positron emission tomography\/computed tomography have a role in cervical nodal staging for esophageal squamous cell carcinoma?","volume":"160","author":"Li","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"2026012209533760900_ref9","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1159\/000193630","article-title":"Additional value of external ultrasonography of the neck after CT and PET scanning in the preoperative assessment of patients with esophageal cancer","volume":"26","author":"Omloo","year":"2009","journal-title":"Dig Surg"},{"issue":"1","key":"2026012209533760900_ref10","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ejrad.2007.06.022","article-title":"Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction","volume":"67","author":"Schreurs","year":"2008","journal-title":"Eur J Radiol"},{"issue":"6","key":"2026012209533760900_ref11","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1111\/j.1442-2050.2011.01289.x","article-title":"External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography\u2013computed tomography (PET\u2013CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma","volume":"25","author":"Blom","year":"2012","journal-title":"Dis Esophagus"},{"issue":"12","key":"2026012209533760900_ref12","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The STROBE statement: guidelines for reporting observational studies","volume":"12","author":"Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"11","key":"2026012209533760900_ref13","doi-asserted-by":"publisher","first-page":"e012799","DOI":"10.1136\/bmjopen-2016-012799","article-title":"STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration","volume":"6","author":"Cohen","year":"2016","journal-title":"BMJ Open"},{"issue":"22","key":"2026012209533760900_ref14","doi-asserted-by":"publisher","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","author":"Hagen","year":"2012","journal-title":"N Engl J Med"},{"issue":"5","key":"2026012209533760900_ref15","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1053\/j.sult.2017.05.005","article-title":"Chapter 5 ultrasound characteristics of benign vs malignant cervical lymph nodes","volume":"38","author":"Prativadi","year":"2017","journal-title":"Semin Ultrasound CT MR"},{"issue":"5","key":"2026012209533760900_ref16","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/S0009-9260(02)00584-6","article-title":"Sonography of neck lymph nodes. Part I: normal lymph nodes","volume":"58","author":"Ying","year":"2003","journal-title":"Clin Radiol"},{"issue":"5","key":"2026012209533760900_ref17","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/S0009-9260(02)00585-8","article-title":"Sonography of neck lymph nodes. Part II: abnormal lymph nodes","volume":"58","author":"Ahuja","year":"2003","journal-title":"Clin Radiol"},{"issue":"8","key":"2026012209533760900_ref18","doi-asserted-by":"publisher","first-page":"2146","DOI":"10.21037\/jtd.2016.07.71","article-title":"Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis","volume":"8","author":"Leng","year":"2016","journal-title":"J Thorac Dis"},{"issue":"3","key":"2026012209533760900_ref19","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jnci.2011.09.009","article-title":"Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy","volume":"23","author":"Hafez","year":"2011","journal-title":"J Egypt Natl Canc Inst"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/1\/doaf135\/66538289\/doaf135.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/1\/doaf135\/66538289\/doaf135.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:53:42Z","timestamp":1769093622000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doaf135\/8437972"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,9]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doaf135","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,9]]},"article-number":"doaf135"}}