Evaluation of metastatic lymph nodes in cN0 thoracic esophageal cancer patients with inconsistent pathological lymph node diagnosis

Abstract

Background Preoperative clinical diagnosis of lymph node (LN) metastasis and subsequent pathological diagnosis are often not in agreement. Detection of false-negative LNs is essential in selecting an optimal treatment strategy, and most importantly, the presence of false-negative LN is itself a significant prognostic indicator. Therefore, at present, there is an urgent need to establish more accurate and individualized evaluation methods for LN metastasis. Methods Of 213 cN0 patients who underwent curative esophagectomy without preoperative neoadjuvant treatment, 60 (28%) had LN metastasis diagnosed pathologically. There were 129 false-negative LNs, of which 85 were detectable by preoperative computed tomography (CT). We retrospectively investigated the distribution, frequency, and characteristics of pathologically positive nodes in patients with clinically N0 esophageal cancer. Results The paracardial region was the most frequent region of false-negative LNs, accounting for 26% (22 LNs) of the total incidence. False-negative LNs distributed widely from the neck to the abdomen in patients with a primary tumor in the middle thoracic esophagus. In patients with a primary tumor in the lower thoracic esophagus, four false-negative LNs were detected in the superior mediastinum. When the short-axis diameter, shape, and attenuation patterns of the LNs were used as criteria for metastasis diagnosis, they were insufficient for an accurate diagnosis. However, false-negative LNs in the most frequently occurring sites are characterized by smaller short-axis, suggesting that accurate diagnosis cannot be made unless the diagnostic criteria for the short-axis are reduced in addition to shape and attenuation. Conclusions Although restrictive to the most frequent regions of false-negative LNs occur, reducing size criterion and consideration of their shape and attenuation may contribute to improved diagnosis.

Unresected small lymph node assessment predicts prognosis for patients with pT3N0M0 thoracic esophageal squamous cell carcinoma

“…However, the accuracy of CT is unsatisfactory when LNs greater than 10-mm diameter are considered positive for metastasis [ 33 , 34 ]. Wakita et al [ 35 ] found that among the 213 patients who were diagnosed as cN0 by CT and underwent curative esophagectomy without preoperative neoadjuvant treatment, 60 (28%) patients had LN metastasis diagnosed pathologically. An important limitation was that metastatic lymph nodes might present without an apparent enlargement in size.…”

“…Even with PET/CT, a large number of small metastatic lesions can be difficult to detect [ 33 , 38 , 39 ]. A previous study has reported that lowering the size criteria and combining the axial ratio (short-axis diameter/long-axis diameter) would increase sensitivity [ 16 , 35 , 40 ]. Therefore, in the present study, LNs were diagnosed as suspected metastatic nodes in the absence of pathological confirmation, when the short-axis diameter exceeding 5 mm and the shape of the node was round (axial ratio exceeding 0.66).…”

Mapping of Cervical and Upper Mediastinal Lymph Node Recurrence for Guiding Clinical Target Delineation of Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma

“…As a result, there might be some errors in the nodal mapping. Furthermore, the optimal imaging diagnostic criteria of LNR remain controversial (22)(23)(24). More studies with large sample sizes in different centers are needed to verify our results.…”

Unresected Small Lymph Nodes Assessment Predict Prognosis For Patients With pT3N0M0 Thoracic Esophageal Squamous Cell Carcinoma

“…Even with PET/CT, a large number of small metastatic lesions can be di cult to detect [34,38,39]. A previous study has reported that lowering the size criteria and combining the axial ratio (short-axis diameter/long-axis diameter) would increase sensitivity [16,40,41]. Therefore, in the present study, LNs were diagnosed as suspected metastatic nodes in the absence of pathological con rmation, when the short-axis diameter exceeding 5 mm and the shape of the node was round (axial ratio exceeding 0.66).…”