Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: Histomorphologic analysis

Abstract

In patients with squamous cell carcinoma of the esophagus, the preoperative clinical staging of the N category is primarily based on the lymph node size. Lymph nodes > 10 mm are considered to be tumor-infiltrated. This histopathologic study investigated the correlation of lymph node size and metastatic infiltration in esophageal carcinoma of patients with and without neoadjuvant radiochemotherapy. The specimens of 40 patients with squamous cell carcinoma of the esophagus were included in a prospective morphometric study. Half of these patients (n = 20) received preoperative radiochemotherapy. The number of resected lymph nodes were counted, and the largest diameter of each node was measured. Metastatic involvement of each node was analyzed by histologic examination. The frequency of lymph node metastases was calculated and correlated to the lymph node size. A total of 1196 lymph nodes with an average of 29.9 nodes per patient were resected and analyzed; 129 lymph nodes (10.8%) showed metastatic infiltration. The average size of 1067 tumor-free lymph nodes was 5.1 +/- 3.8 mm in maximum diameter, whereas the average size of 129 metastatic lymph nodes was 6.7 +/- 4.2 mm (p = 0.00006). Of all resected lymph nodes, 761 (63.6%) were < or = 5 mm in maximum diameter. Only 9.3% (n = 111) of all resected lymph nodes were > 10 mm in maximum diameter. There was no significant correlation between lymph node size and the frequency of nodal metastases. No difference in size could be demonstrated between patients with and without neoadjuvant radiochemotherapy. Diagnostic imaging techniques using size as the criterion of nodal infiltration cannot exactly assess the nodal status of patients with esophageal carcinoma. This is also true for patients after neoadjuvant radiochemotherapy. Therefore, evaluation of the nodal status in patients with squamous cell carcinoma of the esophagus is entirely based on pathohistologic analysis after a well defined lymphadenectomy.

Diagnostic performance of diffusion-weighted magnetic resonance imaging in esophageal cancer

“…Schröder et al [5] retrospectively analyzed a total of 1,196 resected lymph nodes of 40 patients with squamous cell carcinoma of the esophagus. The average size of 1,067 tumor-free lymph nodes was 5.1±3.8 mm in maximum diameter, whereas the average size of 129 metastatic lymph nodes was 6.7±4.2 mm.…”

“…18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) or combined FDG-PET/CT may be of additional value in the detection of distant metastases [6,7]. EUS, CT, and FDG-PET(/CT) are of relatively limited value, however, in the detection of locoregional lymphnode involvement [3][4][5][6][7], whereas the presence and number of lymph-node metastases are important independent predictors for the likelihood of developing systemic disease and long-term survival [3], and the presence of lymph-node metastases may require neoadjuvant chemotherapy or chemoradiotherapy [8]. Furthermore, although EUS combined with fine-needle aspiration (FNA) of suspicious lymph nodes may currently be the most accurate preoperative method for determining nodal status, it is invasive and cannot be performed in the area of the primary tumor because of the risk of tumor seeding [3,9].…”

Multidetector CT Assessment of Lymph Node Size for Nodal Staging in Patients with Potentially Operable Squamous Esophageal Cancer and the18F-FDG Positron Emission Tomography CT Correlation

“…Schröder et al (11) reported that among 1,196 surgically resected LNs in primary esophageal squamous cell cancer patients, metastasis could be confirmed in 129 LNs (10.8%) by histopathologic analysis. Among these 129 LNs, there were only 15 with a diameter > 10 mm (12%).…”

Efficacy and toxicity of nimotuzumab combined with radiotherapy in elderly patients with esophageal squamous cell carcinoma

“…Bronchoscopy was performed if considered necessary. The clinical tumor-node-metastasis (cTNM) stage was determined according to the 7th American Joint Committee on Cancer TNM staging system (16) according to the CT scan findings (17).…”