scholarly journals Use of Immunostaining for the Diagnosis of Lymphovascular Invasion in Superficial Barrett’s Esophageal Adenocarcinoma

2020 ◽  
Author(s):  
Isao Hosono ◽  
Ryoji Miyahara ◽  
Kazuhiro Furukawa ◽  
Kohei Funasaka ◽  
Tsunaki Sawada ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Lymphovascular Invasion ◽  
Clinical Information ◽  
Depth Of Invasion ◽  
Muscularis Mucosa ◽  
Treatment Results ◽  
Node Metastasis ◽  
Hematoxylin And Eosin ◽  
Barrett’S Esophageal Adenocarcinoma

Abstract Background: The prevalence of Barrett’s esophageal adenocarcinoma (BEA) is increasing in Japan. Accurate assessment of lymphovascular invasion (LVI) after endoscopic resection or surgery is essential in evaluating treatment response. This study aimed to assess the usefulness of immunostaining in determining the extent of LVI in superficial BEA. Methods: We retrospectively included 41 patients who underwent endoscopic resection or surgery between January 2007 and July 2018. In all cases, 3-µm serial sections from paraffin-embedded resected specimens were used for hematoxylin and eosin (H-E) staining and immunostaining for D2-40 and CD31. Two specialized gastrointestinal pathologists (T.Y. and T.T), blinded to clinical information, independently evaluated the extent of LVI from these specimens. The LVI-positivity rate was evaluated with respect to the depth of invasion, changes in the positivity rate on immunostaining, pathological characteristics of patients with LVI, lymph node metastasis or relapse, and course after treatment. Results: H-E staining alone identified LVI in 7 patients (positivity rate: 17.1%). Depths of invasion were categorized based on extension to the submucosa (SM) or deeper. On immunostaining for D2-40 and CD31, additional positivity was detected in 2 patients with SM1 and 1 SM3, respectively; LVI was detected in 10 patients (positivity rate: 24.4%). LVI-positivity rates with invasion of the superficial muscularis mucosa (SMM)/lamina propria (LPM)/deep muscularis mucosa (DMM), SM 1, 2, and 3 were 0%, 75%, 28.6%, and 55.6%, respectively. Conclusions:Combined H-E staining and immunostaining is useful in diagnosing LVI in superficial BEA, particularly in endoscopically resected specimens.

scholarly journals Use of Immunostaining for the Diagnosis of Lymphovascular Invasion in Superficial Barrett’s Esophageal Adenocarcinoma

2020 ◽  
Author(s):  
Isao Hosono ◽  
Ryoji Miyahara ◽  
Kazuhiro Furukawa ◽  
Kohei Funasaka ◽  
Tsunaki Sawada ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Lymphovascular Invasion ◽  
Clinical Information ◽  
Depth Of Invasion ◽  
Muscularis Mucosa ◽  
Node Metastasis ◽  
Pathological Characteristics ◽  
Hematoxylin And Eosin ◽  
Barrett’S Esophageal Adenocarcinoma

Abstract Background: The prevalence of Barrett’s esophageal adenocarcinoma (BEA) is increasing in Japan. Accurate assessment of lymphovascular invasion (LVI) after endoscopic resection or surgery is essential in evaluating treatment response. This study aimed to assess the usefulness of immunostaining in determining the extent of LVI in superficial BEA.Methods: We included 41 patients who underwent endoscopic resection or surgery between January 2007 and July 2018. In all cases, 3-µm serial sections from paraffin-embedded resected specimens were used for hematoxylin and eosin (H-E) staining and immunostaining for D2-40 and CD31. A specialized gastrointestinal pathologist (T.Y.), blinded to clinical information, evaluated the extent of LVI from these specimens. The LVI-positivity rate was evaluated with respect to the depth of invasion, changes in the positivity rate on immunostaining, pathological characteristics of patients with LVI, lymph node metastasis or relapse, and course after treatment.Results: H-E staining alone identified LVI in 7 patients (positivity rate: 17.1%). Depths of invasion were categorized based on extension to the submucosa (SM) or deeper. On immunostaining for D2-40 and CD31, additional positivity was detected in 2 and 1 patients with SM1 and 1 SM3, respectively; LVI was detected in 10 patients (positivity rate: 24.4%). LVI-positivity rates with invasion of the superficial muscularis mucosa (SMM)/lamina propria (LPM)/deep muscularis mucosa (DMM), and SM 1, 2, and 3 were 0%, 75%, 28.6%, and 55.6%, respectively.Conclusions: Combined H-E staining and immunostaining is useful in diagnosing LVI in superficial BEA, particularly in endoscopically resected specimens.

scholarly journals Use of Immunostaining for the diagnosis of Lymphovascular invasion in superficial Barrett’s esophageal adenocarcinoma

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Isao Hosono ◽  
Ryoji Miyahara ◽  
Kazuhiro Furukawa ◽  
Kohei Funasaka ◽  
Tsunaki Sawada ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Lymphovascular Invasion ◽  
Barrett’S Esophageal Adenocarcinoma

scholarly journals Lymphovascular invasion and lymph node metastasis rates in papillary adenocarcinoma of the stomach: implications for endoscopic resection

2017 ◽  
Vol 21 (4) ◽  
pp. 680-688 ◽  
Author(s):  
Byung-Hoon Min ◽  
Sun-Ju Byeon ◽  
Jun Haeng Lee ◽  
Kyoung-Mee Kim ◽  
Ji Yeong An ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Resection ◽  
Lymphovascular Invasion ◽  
Papillary Adenocarcinoma ◽  
Node Metastasis

scholarly journals Tumor location is a risk factor for lymph node metastasis in superficial Barrett’s adenocarcinoma

2017 ◽  
Vol 05 (09) ◽  
pp. E868-E874 ◽  
Author(s):  
Masayoshi Yamada ◽  
Ichiro Oda ◽  
Hirohito Tanaka ◽  
Seiichiro Abe ◽  
Satoru Nonaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Lymph Node ◽  
Lymphovascular Invasion ◽  
Tumor Location ◽  
Depth Of Invasion ◽  
Tumor Depth ◽  
Factors Associated ◽  
Node Metastasis ◽  
Barrett’S Adenocarcinoma

Abstract Background and study aims Endoscopic treatment is indicated for superficial Barrett’s adenocarcinoma (BA) with a negligible risk of lymph node metastasis (LNM). However, risk factors associated with LNM in superficial BA are still not well characterized. The aim of the current study was to clarify risk factors for LNM of superficial BA. Patients and methods A retrospective study was conducted in 87 consecutive patients with BA that was resected at National Cancer Center Hospital, Tokyo, Japan between 1990 and 2013. We assessed tumor size, macroscopic type, histological type, tumor depth of invasion, lymphovascular invasion and tumor location to analyze factors associated with LNM. Tumor location was classified into following 2 groups according to Siewert classification: 1) BA of the esophagogastric junction (EGJ-BA) as those having their center within 1 cm proximal from the EGJ; and 2) Esophageal-BA as those having their center at 1 cm or more proximal to the EGJ. EGJ was defined as distal end of the palisade vessels. Results LNM was detected in 10 (11 %) patients. Univariable analysis revealed that tumor size, tumor depth of invasion, histological type of mixed differentiated and undifferentiated-type adenocarcinoma, lymphovascular invasion and tumor location of esophageal-BA were significantly associated with LNM. Multivariable analysis revealed that tumor location of esophageal-BA [odds ratio 7.8 (95 %CI: 1.3 – 48.1)] was a potential risk factor for LNM. Conclusions The current study demonstrated that tumor location is a potential risk factor for LNM in BA. Therefore, indications for endoscopic treatment of esophageal-BA and EGJ-BA could be different.

scholarly journals Predictive relevance of lymphovascular invasion in T1 colorectal cancer before endoscopic treatment

2017 ◽  
Vol 05 (12) ◽  
pp. E1278-E1283 ◽  
Author(s):  
Kazuya Inoki ◽  
Taku Sakamoto ◽  
Hiroyuki Takamaru ◽  
Masau Sekiguchi ◽  
Masayoshi Yamada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Treatment ◽  
Lymphovascular Invasion ◽  
Lesion Size ◽  
Depth Of Invasion ◽  
Predictive Risk Factor ◽  
Node Metastasis ◽  
Younger Age

Abstract Background and aim The depth of tumor invasion is currently the only reliable predictive risk factor for lymph node metastasis before endoscopic treatment for colorectal cancer. However, the most important factor to predict lymph node metastasis has been suggested to be lymphovascular invasion rather than the depth of invasion. Thus, the aim of this study was to investigate the predictive relevance of lymphovascular invasion before endoscopic treatment. Methods The data on pT1 colorectal cancers that were resected endoscopically or surgically from 2007 to 2015 were retrospectively reviewed. The cases were categorized into two groups: positive or negative for lymphovascular invasion. The following factors were evaluated by univariate and multivariate analyses: age and sex of the patients; location, size, and morphology of the lesion; and depth of invasion. Results The positive and negative groups included 229 and 457 cases, respectively. Younger age (P < 0.01), smaller lesion size (P = 0.01), non-LST (LST: laterally spreading tumor) (P < 0.01), presence of depression (P < 0.01), and pT1b (P < 0.01) were associated with lymphovascular invasion. In multivariate analysis, younger age (comparing patients aged ≤ 64 years with those aged > 65 years, OR, 1.81; 95 %CI, 1.29 – 2.53), presence of depression (OR, 1.97; CI, 1.40 – 2.77), non-LST features (OR, 1.50; CI, 1.04 – 2.15), and pT1b (OR, 3.08; CI, 1.91 – 4.97) were associated with lymphovascular invasion. Conclusion Younger age, presence of depression, T1b, and non-LST are associated with lymphovascular invasion. Therefore, careful pathological diagnosis and surveillance are necessary for lesions demonstrating any of these four factors.

scholarly journals Endoscopic resection of Barrett’s adenocarcinoma: Intramucosal and low-risk tumours are not associated with lymph node metastases

2020 ◽  
pp. 205064062095890
Author(s):  
Nicolas Benech ◽  
Marc O’Brien ◽  
Maximilien Barret ◽  
Jérémie Jacques ◽  
Gabriel Rahmi ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Lymph Node Metastasis ◽  
Endoscopic Resection ◽  
Low Risk ◽  
Oesophageal Adenocarcinoma ◽  
Depth Of Invasion ◽  
Histological Features ◽  
Node Metastasis

Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma. Methods We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (≤1000 µm) and deep submucosal (>1000 µm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low-risk or a high-risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2-mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow-up from histological or PET CT reports when an invasive procedure was not possible. Results In total, 188 superficial oesophageal adenocarcinomas were included with a median follow-up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas ( n = 135) even with high-risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 µm developed lymph node metastasis tumours ( n = 10/53; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000-µm threshold for all low-risk tumours (0/25), nor under 1200 µm (0/1) and three over this threshold (3/13, 23.1%). Conclusion Intramucosal and low-risk tumours with shallow submucosal invasion up to 1200 µm were not associated with lymph node metastasis during follow-up. In case of high-risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.

scholarly journals Possible indication of endoscopic resection in undifferentiated early gastric cancer

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Dae Gon Ryu ◽  
Cheol Woong Choi ◽  
Su Jin Kim ◽  
Dae Hwan Kang ◽  
Hyung Wook Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Resection ◽  
Lymphovascular Invasion ◽  
Signet Ring Cell ◽  
Cell Type ◽  
Factors Associated ◽  
Node Metastasis ◽  
Signet Ring ◽  
Ring Cell

AbstractEndoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option. To date, endoscopic resection for undifferentiated EGC is being investigated. We evaluated the risk of lymph node metastasis in undifferentiated EGC by examining the preoperative endoscopic findings and operated pathologic specimen. The medical records of patients who underwent surgical resection because of undifferentiated EGC between November 2008 and December 2015 were reviewed retrospectively. The risk factors associated with lymph node metastasis and the lymph node metastasis rate in the expanded indication of undifferentiated EGC were evaluated. A total of 376 patients with undifferentiated EGC (233 signet ring cell type and 143 poorly differentiated type) were analyzed. Lymph node metastasis was found in 9.8% of the patients. Among the patients who met the expanded criteria (59 patients), only one patient had lymph node metastasis (signet ring cell type without ulceration and 15 mm in size). The risk factors associated with lymph node metastasis were lesion size >20 mm (OR 3.013), scar deformity (OR 2.248), surface depression (OR 2.360), submucosal invasion (OR 3.427), and lymphovascular invasion (OR 6.296). Before endoscopic resection of undifferentiated EGC, careful selection of patients should be considered. The undifferentiated EGC with size ≥15 mm, scar deformity, surface depression, submucosal invasion, and lymphovascular invasion should be considered surgical resection instead of endoscopic resection.

scholarly journals Depth of invasion determined by MRI in cT1N0 tongue: is it an indicator for elective neck dissection?

2019 ◽  
Author(s):  
Chunmiao Xu ◽  
Junhui Yuan ◽  
Liuqing Kang ◽  
Xiaoxian Zhang ◽  
Lifeng Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neck Dissection ◽  
Lymphovascular Invasion ◽  
Cox Model ◽  
Elective Neck Dissection ◽  
Depth Of Invasion ◽  
Neck Lymph Node ◽  
Node Metastasis ◽  
Neck Lymph Node Metastasis

Abstract Abstracts Background Depth of invasion (DOI) could be calculated by MRI preoperatively, whether MRI-determined DOI could predict the prognosis and whether it could be used as an indicator for neck dissection for cT1N0 tongue squamous cell carcinoma (SCC) remain unknown, the main goal of the current study aimed to answer the questions. Methods Patients with surgically treated cT1N0 tongue SCC were retrospectively enrolled, MRI-determined DOI was measured based on T1-weigthed layers by a 1.5T scan. A multivariate logistic regression analysis model was used to determine the independent predictors for occult neck lymph node metastasis. The main study endpoints were locoregional control survival (LRC) and disease specific survival (DSS), the Cox model was used to determine the independent prognostic factors for the LRC and DSS. Results Occult neck lymph node metastasis was noted in 26 (17.2%) patients, ROC curve indicated the optimal cutoff value of MRI-determined DOI was 7.5mm for predicting neck lymph node metastasis with sensitivity of 86.9%. The factors of lymphovascular invasion, MRI-determined DOI, pathologic DOI, and pathologic tumor grade were significantly associated with the presence of neck lymph node metastasis in univariate analysis, further logistic regression analysis confirmed the independence of lymphovascular invasion, MRI-determined DOI, and pathologic DOI in predicting the neck lymph node metastasis. The 5-year LRC and DSS rates were 84% and 90%, respectively. Cox model analysis suggested the MRI-determined DOI was an independent prognostic factor for both the LRC and DSS. Conclusions Elective neck dissection is suggested if MRI-determined DOI is greater than 7.5mm in cT1N0 tongue SCC, and MRI-determined DOI ≥7.5mm indicates more risk for disease recurrence and cancer caused death.

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