Abstract
Background
In esophageal adenocarcinoma clinical staging (cStaging), interest for N-descriptor according to single lymph nodal station has emerged, but no specific data are available. CT, PET, EUS sensitivity/specificity for N-descriptor in single stations were investigated.
Methods
In 101 esophageal adenocarcinoma cases (60/41 Siewert I/II) preoperative staging and primary radical surgical resection (prospective protocols) were performed. Resected lymphatic nodes (LNY) and lymphatic metastases (LNM) were reported for the following stations: A) right paratracheal/sub carinal/pulmonary ligament; B) paraesophageal thoracic; C) pericardial; D) left gastric artery, lesser curvature; E) celiac trunk, hepatic/splenic artery. Pathological N data were compared with clinical N-descriptors.
Results
LN stations: A) LNY 137 LNM 6, Sensitivity CT 58.3%, PET 7.1%, EUS 87.5%—Specificity CT 94.3%, PET 98.8%, EUS 88.6%; B) LNY 79 LNM 18, Sensitivity CT 33.3%, PET 20%, EUS 80%—Specificity CT 92.1%, PET 96.6%, EUS 87.2%; C) LNY189 LNM 36, Sensitivity CT 46.6%, PET 23.5%, EUS 28.5%—Specificity CT 95.3%, PET 97.5%, EUS 97.7%; D) LNY 383 LNM 66, Sensitivity CT 24.1%, PET 21.4%, EUS 33.3%—Specificity CT 97.2%, PET 97.2%, EUS 100%; E) LNY 148 LNM 17, Sensitivity CT 13.3%, PET 5.5%, EUS 33.3%—Specificity CT 93%, PET 98.7%, EUS 95.2%. Figure Staging in adenocarcinoma of the esophageal-gastric junction; CT (A), PET (B) and fused PET/CT sessions (C) at the level of the primary tumor (red arrows) and para-esophageal lymph nodes including one PET-positive (red arrowheads), and one PET-negative detectable on CT only (yellow arrowheads). Panel D the box-plot for median SUVmax according to pathologic lymph node status. In the true positive lymph nodes, SUVmax was significantly higher than in true negative (median, 13.6 vs 5.0, P = 0.001) and false negative lymph nodes (median, 13.6 vs 6.9; P = 0.026). Abbreviations: FN = false negative; TP = true positive; TN = true negative.
Conclusion
For esophageal adenocarcinoma cStaging, CT, PET, EUS N-descriptor is not reliable, particularly PET data for N stations close to primary T. To tailor therapy, new biological descriptors are necessary.
Disclosure
All authors have declared no conflicts of interest.