Πέμπτη 16 Ιανουαρίου 2020

Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer

2019 Sep;26(9):2874-2881. doi: 10.1245/s10434-019-07498-2. Epub 2019 Jun 17.

Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer.

Aoyama J1, Kawakubo H2, Mayanagi S1, Fukuda K1, Irino T1, Nakamura R1, Wada N1, Suzuki T3, Kameyama K4, Kitagawa Y1.

Author information

1: Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
2: Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. hkawakubo@keio.jp.
3: Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
4: Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

Abstract

BACKGROUND:

Recent advances in endoscopic examinations have resulted in the detection of a larger number of early esophageal cancers; however, there have been many cases with clinically negative but pathologically positive lymph node metastasis (LNM). In this study, we aimed to evaluate the discrepancy between the clinical and pathological diagnoses of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer, and assess LNM size in these patients to clarify the presence of LNM that cannot be detected with current modalities.

METHODS:

This study included 50 patients who underwent surgery for cT1a-MM/cT1b N0M0 thoracic esophageal squamous cell carcinoma between January 2012 and November 2016 at our institution. The maximum size of involved LNs and metastatic nests were measured, and the distribution of LNM was investigated.

RESULTS:

Of the 50 patients, 13 (26%) had LNM on pathological examination. Lymphatic invasion was significantly more frequent in the LNM-positive group than in the LNM-negative group (p = 0.005). The median sizes of 28 involved LNs and metastatic nests were 3 and 1.6 mm, respectively. Of these LNs, 20 (71%) were classified as micrometastases (≤ 2 mm). The involved nodes were distributed across three fields.

CONCLUSIONS:

There was a discrepancy between the clinical and final pathological findings of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer. The detection of involved nodes with current modalities in these patients was difficult because of the small size of LNM. Therefore, continued strong consideration for extended LN dissection is necessary in these patients to ensure appropriate diagnosis and treatment.