[Mediastinal lymph node metastasis from esophageal carcinoma: CT assessment with pathologic correlation]

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Mediastinal lymph node metastasis is a critical prognostic factor in esophageal carcinoma.
• Accurate staging of lymph node involvement is essential for treatment planning.

Purpose of the Study:

• To evaluate the accuracy of computed tomographic (CT) scans in detecting mediastinal lymph node metastasis in patients with esophageal carcinoma.
• To compare CT findings with histopathologic results for resected lymph nodes.

Main Methods:

• Computed tomographic (CT) scans were performed on 179 patients with esophageal carcinoma.
• A total of 7,218 resected lymph nodes were analyzed, comparing CT findings with histopathologic results.
• Two criteria for lymph node metastasis on CT were assessed: long transverse diameter (≥10 mm) and short transverse diameter (≥10 mm).

Main Results:

• Using a ≥10 mm long transverse diameter criterion, overall sensitivity was 19% and positive predictive value (PPV) was 33%.
• Using a ≥10 mm short transverse diameter criterion, overall sensitivity was 8% and PPV was 63%.
• Small metastatic nodes (<5 mm) were found in all subgroups, and large non-metastatic nodes were common in certain subgroups (e.g., 107, 109), leading to low accuracy.

Conclusions:

• Computed tomography (CT) is not an accurate method for assessing mediastinal lymph node metastasis in esophageal carcinoma.
• The size criteria used in CT scans often fail to correctly identify metastatic or non-metastatic lymph nodes.
• Further research may be needed to improve imaging techniques for lymph node staging in esophageal cancer.