Evaluation of metastatic lymph nodes in cN0 thoracic esophageal cancer patients with inconsistent pathological lymph node diagnosis

Abstract Background Although various modalities including CT, endoscopy, and positron emission tomography (PET) have been used to predict pathological tumor response (pTR) to neoadjuvant chemotherapy (NACT) or prognosis in esophageal cancer patients, an optimal method of response evaluation remains to be established. Methods A total of 97 non-T4 thoracic esophageal cancer patients who underwent curative surgery after NACT from 2011 to 2014 with both measurable primary tumors (PT) and metastatic lymph nodes (LNs) by CT (≥ 10mm in short axis or ≥ 5mm in short axis with SUV-max ≥ 2.5) were analyzed. Patients with ≥ 50% decrease in size of the PT (two-direction measurement) and ≥ 30% decrease in size of LNs (sum of short diameter based on RECIST criteria) were defined as PT- and LNs-responders, respectively. Results The median reduction rate of PT and LNs were 62.0% (5.5–93.4) and 26.7% (60.9–13.6), respectively. Of 97 patients, 62 (69%) and 45 patients (45%) were classified as PT- and LNs-responders respectively. The concordance rate between CT response of PT and LNs was 66% (P = 0.01). CT response of PT was correlated with pTR (P<0.0001) while CT response of LNs was associated with pT (P = 0.0011), pN(P = 0.0004), and pTR (P < 0.0001). Receiver operating characteristic (ROC) curves demonstrated the highest accuracy (AUC 0.75), sensitivity (88.9%) and specificity (60.9%) at the reduction rate of 53% (P = 0.007) which was approximated to the cutoff value we used. In univariate analysis of recurrence free survival (RFS), pT, pN, pM, CT response of both PT and LNs, and pTR were significantly correlated with RFS. Multivariate analysis further identified CT response of LNs (HR 2.68 P = 0.003) and pTR (HR 2.72 P = 0.022) to be independently associated with RFS. When classified into three groups by histological grade and CT response of LNs [group A (grade2–3/LNs-responders), group B (grade1a-1b/LNs-nonresponders), and group C (others)], 2-year RFS were 83% in the groupA, 59% in groupC and 29% in groupB (P < 0.0001), respectively. Conclusion In locally-advanced esophageal cancer patients with NACT followed by surgery, CT response of PT and LNs significantly correlated with pTR. Especially, CT response of LNs was important to predict prognosis in addition to pTR. Disclosure All authors have declared no conflicts of interest.

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Molecular Changes in Pre-Metastatic Lymph Nodes of Esophageal Cancer Patients

PLoS ONE ◽

10.1371/journal.pone.0102552 ◽

2014 ◽

Vol 9 (7) ◽

pp. e102552 ◽

Cited By ~ 5

Author(s):

Benjamin Otto ◽

Alexandra M. Koenig ◽

Genrich V. Tolstonog ◽

Anke Jeschke ◽

Kristin Klaetschke ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Molecular Changes ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

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Differentiating metastatic lymph nodes in lung cancer patients based on endobronchial ultrasonography features

Medical Ultrasonography ◽

10.11152/mu-1282 ◽

2018 ◽

Vol 20 (2) ◽

pp. 154 ◽

Cited By ~ 1

Author(s):

Ching-Kai Lin ◽

Lih-Yu Chang ◽

Kai-Lun Yu ◽

Yueh-Feng Wen ◽

Hung-Jen Fan ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Predictive Factors ◽

Short Axis ◽

Metastatic Lymph Nodes ◽

Lung Cancer Patients ◽

Metastatic Lymph ◽

Sum Score

Aim: The aim of this study was to identify easy and relatively effective ultrasound criteria for metastatic mediastinal lymph node prediction. Materials and methods: A retrospective chart review of patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from March 2014 to September 2016 was performed. We used the following EBUS sonographic features for metastatic lymph node prediction: 1) length of the short axis, 2) shape, 3) margin, 4) echogenicity, 5) central hilar structure, and 6) coagulation necrosis sign. These sonographic findings were compared with the final pathology results or clinical follow-up. Results: A total of 227 lymph nodes were retrospectively evaluated in 133 lung cancer patients; 72% of the lymph nodes had been proven to be malignant metastasis. Logistic regression analysis revealed that the length of the short axis, shape, margin, and echogenicity were independent predictive factors for metastasis. We developed a sum score based on these four sonographic features. A larger sum score trended toward a greater possibility of malignancy. If all four predictive factors were preserved, the diagnostic accuracy, the value of the specificity and the positive predictive value of the sonographic feature would be higher than 90%. Conclusions: The sonographic features of EBUS are valuable tools in predicting metastatic lymph nodes in lung cancer patients.

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