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 ...