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Biologic and imaging diagnosis of lymph node metastasis in esophageal carcinoma
Shoji Natsugoe1, Saburo Nakashima, Masataka Matsumoto
1First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan. natsugoe@m2.kufm.kagoshima-u.ac.jp
Background And Objectives:
Few reports have described the combined use of biologic and imaging techniques in the diagnosis of lymph node metastasis. We prospectively evaluated lymph node metastasis diagnosed by biologic and imaging means in patients with esophageal carcinoma.
Methods:
Preoperative ultrasound and endoscopic ultrasound (EUS) examination were performed in 80 patients. Biopsy specimens were immunohistochemically examined using cyclin D1 (CD1) and desmoglein 1 (DG1) antibodies, and tumors were classified into three grades.
Results:
The sensitivity, specificity, and accuracy values of ultrasound examination were 88.2, 58.6, and 77.5%, respectively. The incidence of nodal involvement was 0% (0/10) in patients with grade 1 tumors, 57.1% (16/28) in those with grade 2 tumors, and 83.3% (35/42) in those with grade 3 tumors. Of the 57 patients with lymph node metastasis determined sonographically, 50 had grade 2 or 3 tumors that were histologically confirmed. The remaining seven patients with grade 1 tumors did not have involved nodes. Of the 23 patients without lymph node metastasis according to ultrasound examination, the incidence of lymph node metastasis in patients with grade 1, 2, and 3 tumors was 0, 16.7, and 50.0%, respectively.
Conclusions:
When used together, imaging and molecular procedures may offer improved identification of lymph node metastasis in patients with squamous cell carcinoma of the esophagus.