Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases

Eguchi, Takako; Nakanishi, Yukihiro; Shimoda, Tadakazu; Iwasaki, Motoki; Igaki, Hiroyasu; Tachimori, Yuji; Kato, Hoichi; Yamaguchi, Hideyo; Saito, Daizo; Umemura, Satoshi

doi:10.1038/modpathol.3800557

Cited by 261 publications

(222 citation statements)

References 13 publications

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“…Moreover, endoscopic mucosal resection (EMR) may be indicated for the treatment of patients with m3 or sm1 cancer without these characteristics (13). another study showed that additional treatment, such as radiotherapy, was necessary for patients with tumors that were pathologically diagnosed as being m3 cancer with ly or sm1 cancer after EMR (3,14). Using a multivariate analysis Tajima et al showed, in the almost same manner as in our study, that the risk factor of lymph node metastasis in esophageal cancer was only ly (6).…”

Section: Discussionsupporting

confidence: 66%

“…Esophageal cancers extending to the intraepithelium (m1) or lamina propria (m2), in particular, rarely have lymph node metastasis or lymphatic invasion (ly) and are thus curative by local treatment and suitable for treatment with EMR/ ESD (1,2). On the other hand, the frequency of lymph node metastasis from cancer of the muscularis mucosa (m3) or the upper third of the submucosal layer (sm1) is 18.0 and 53.1%, respectively (3). In certain cases local treatment alone would be adequate; however, in other cases treatment for lymph node metastasis would need to be considered.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

Ozawa¹,

Saikawa²,

Kitagawa³

2010

Oncology Letters

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Abstract.We studied the surgical treatments of patients with either esophageal cancer reaching to the muscularis mucosae (m3) or with a slight invasion of the submucosa (sm1). We reviewed the records and examined the clinicopathological features of 29 patients with m3 or sm1 esophageal squamous cell carcinoma who had undergone surgery. Lymph node metastasis was noted in 6.3% (1 patient) of patients with m3 cancers and in 38.5% (5 patients) of those with sm1 cancers. The incidence of lymph node metastasis was higher in the sm1 than in the m3 group, but the difference was not significant. Lymphatic invasion (ly) was noted in 12.3% (2 patients) of patients with m3 cancers and in 53.8% (7 patients) of those with sm1 cancers. The incidence of ly was significantly higher in the sm1 group than in the m3 group (P<0.05). In a multivariate analysis of factors for predicting lymph node metastasis, the presence of ly was the only significant predictor (P<0.05). The preoperative diagnostic accuracies of endoscopic ultrasonography (EUS), esophagogastroduodenoscopy (EGD) and an upper gastrointestinal series (UGS) for predicting depth of invasion were 27.8, 31.0 and 41.4%, respectively, with the majority of the misdiagnoses being overestimations. In conclusion, we suggested that ly is associated with lymph node metastasis in m3 or sm1 esophageal cancer. This association is significant for treatment-related decision making. IntroductionRecent diagnostic developments have led to the detection of superficial esophageal cancer. Consequently, an increase in the number of candidates for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been noted. Esophageal cancers extending to the intraepithelium (m1) or lamina propria (m2), in particular, rarely have lymph node metastasis or lymphatic invasion (ly) and are thus curative by local treatment and suitable for treatment with EMR/ ESD (1,2). On the other hand, the frequency of lymph node metastasis from cancer of the muscularis mucosa (m3) or the upper third of the submucosal layer (sm1) is 18.0 and 53.1%, respectively (3). In certain cases local treatment alone would be adequate; however, in other cases treatment for lymph node metastasis would need to be considered. Treatment strategies for m3 and sm1 cancers remain controversial. To provide appropriate treatment for these types of cancer, it would be useful to be able to identify patients that need treatment for lymph node metastasis. Diagnosis of lymph node metastasis from esophageal cancer by computed tomography (CT), ultrasonography and FDG-PET currently lacks accuracy. Subsequently, the accurate diagnosis of esophageal cancer prior to treatment presents a challenge. Depth of superficial esophageal cancer is normally diagnosed using endoscopy, endoscopic ultrasonography and a gastrointestinal series. However, despite the availability of these current modalities, accurate diagnosis of tumor depth remains difficult. If a clear diagnosis prior to treatment for m3 and sm1 esophageal cancer and accurate ...

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Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

Ozawa¹,

Saikawa²,

Kitagawa³

2010

Oncology Letters

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“…A number of retrospective studies involving histopathological analyses of surgically resected specimens of esophageal squamous cell carcinomas (SCCs) have shown that cases of non-invasive epithelial carcinoma (EP, carcinoma in situ) and intra-mucosal invasive carcinoma limited to the lamina propria mucosae (LPM) had an extremely low risk of lymph node and dis-tant metastasis [1][2][3][4][5][6][7] . Based on these findings, the Japanese guidelines state that the indication for ER of esophageal SCC is a lesion limited to EP or LPM.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Honda

Akiho

2012

WJGP

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Endoscopic resection is an effective treatment for noninvasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation.Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

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“…4 Endoscopic resection has been recommended as a local curative approach for (unicentric) mucosal Barrett's adenocarcinoma (m1 or m2, and m3 without lymph vessel infiltration). 5 Surgery is still the therapy of choice in early Barrett's adenocarcinoma infiltrating submucosal layers or poorly differentiated tumors because of a higher risk of lymph-node metastasis. 6 Recently, two studies focused on a-methylacyl coenzyme A racemase (AMACR) in Barrett's neoplastic lesions, an enzyme known to be expressed in prostate and colon cancer.…”

mentioning

confidence: 99%

Expression of α-methylacyl coenzyme A racemase in the dysplasia carcinoma sequence associated with Barrett’s esophagus

Scheil-Bertram¹,

Lorenz²,

Ell³

et al. 2008

Modern Pathology

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Two different studies demonstrated a-methylacyl coenzyme A racemase (AMACR) to be a highly specific marker in Barrett's neoplastic lesions. Reactive atypia was positive in 3/30 cases in these studies. We present a retrospective study of early Barrett's adenocarcinoma treated with surgery (2000-2005, n ¼ 29; M:F ¼ 5:1, median age 67 years). We analyzed the role of AMACR expression in reactive and neoplastic lesions associated with the disease of 77 different specimens (60 biopsy and 17 surgical specimens) of these patients. In our cohort, 70% of cases demonstrated infiltration of the submucosa, 38% were poorly differentiated, and/or 31% demonstrated lymph vessel infiltration. We used a multi-tissue array, with reactive and neoplastic samples for each patient to analyze the immunoreactivity of AMACR. Barrett's epithelium that was negative for dysplasia and columnar epithelial cell changes indefinite for dysplasia (n ¼ 30) did not demonstrate AMACR immunoreactivity. AMACR immunoreactivity was demonstrated in 27% (8/30) of cases of Barrett's epithelium with columnar epithelial cell changes indefinite for dysplasia. Altogether 91% of cases with low-grade dysplasia were AMACR-positive and 96% of cases with high-grade dysplasia and early Barrett's adenocarcinoma were positive for AMACR. In summary, the sensitivity of AMACR expression in low-grade dysplasia and subsequent early Barrett's adenocarcinoma was significantly higher in our study compared with previous data. This might be a new diagnostic marker for dysplasia carcinoma sequence in Barrett's low-grade neoplastic lesions. Further studies are required to investigate this point with well-defined controls having at least 5-years follow-up.

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Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases

Cited by 261 publications

References 13 publications

Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Expression of α-methylacyl coenzyme A racemase in the dysplasia carcinoma sequence associated with Barrett’s esophagus

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