How is malignant lymphadenopathy determined in esophageal cancer?
The presence of four EUS criteria (size > 1 cm, round, well-defined, and hypoechoic) predicts a malignant LN in nearly 100% of cases. However, only 20% to 40% of all malignant LNs have all four EUS criteria. Therefore, when possible, FNA of LN should be performed. The addition of FNA to EUS increases sensitivity and specificity to nearly 90% and 100%, respectively.