P1.113. Optimization of Cervical Lymph Node Ultrasound Partitioning in Esophageal Cancer: A Cross-Sectional Survey of Surgeons and Ultrasound Physicians in China

Abstract

Abstract Topic Esophageal Cancer: New Diagnostic Modalities (Including PET, PET-CT, New Tracers) Background Accurate ultrasound evaluation of cervical lymph nodes (LNs) is essential for staging and treatment planning in esophageal cancer, particularly for decisions regarding three-field lymphadenectomy and neoadjuvant strategies. However, cervical LN assessment in routine ultrasound practice typically follows the AAO-HNS/ASHNS neck level system, which was not designed for esophageal cancer and may not correspond well to oncologic nodal stations defined by the JES or AJCC staging frameworks. This mismatch may limit the clinical interpretability and imaging value of ultrasound reports. Methods We conducted a nationwide, cross-sectional survey among thoracic surgeons and ultrasound physicians from tertiary hospitals across China to evaluate current ultrasound-based cervical LN partitioning practices, familiarity with different nodal classification systems, and the perceived impact of zoning discrepancies on clinical decision-making. The questionnaire also incorporated representative CT and ultrasound images to assess interobserver consistency in imaging-based nodal station identification. Results A total of 312 valid responses were collected from 132 tertiary institutions. All ultrasound physicians (100%) reported using the AAO-HNS system in routine practice, whereas only 2.2% incorporated JES terminology. More than half of surgeons (56.3%) frequently needed to convert ultrasound-reported neck levels into JES/AJCC nodal stations, and 63.8% indicated that such discrepancies influenced preoperative assessment. Both surgeons (91.3%) and ultrasound physicians (87.0%) strongly supported the integration of JES/AJCC-compatible labeling and structured visualization into ultrasound reports. Interobserver agreement for imaging-based nodal station identification was moderate (κ = 0.53), indicating notable variability in anatomical interpretation. Conclusion Current ultrasound-based cervical LN partitioning provides incomplete alignment with esophageal cancer–specific oncologic zoning, resulting in reporting ambiguity and reduced imaging utility in multidisciplinary care. There is strong consensus across imaging and surgical specialties supporting the optimization of ultrasound LN reporting through JES/AJCC-compatible mapping and structured visualization, highlighting an important opportunity to enhance the clinical value of cervical LN ultrasound in esophageal cancer.