Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View

Objective: To investigate the application value of apparent diffusion coefficient value in the pathological type, histologic grade, and presence of lymph node metastases of esophageal carcinoma. Materials and Methods: Eighty-six patients with pathologically confirmed esophageal carcinoma were divided into different groups according to pathological type, histological grade, and lymph node status. All patients underwent conventional magnetic resonance imaging and diffusion-weighted imaging scan, and apparent diffusion coefficient values of tumors were measured. Independent sample t test and 1-way variance were used to compare the difference of apparent diffusion coefficient value in different pathological types, histologic grades, and lymph node status. Correlation between the apparent diffusion coefficient value and the histologic grade was evaluated using Spearman rank correlation test. Receiver operating characteristic curve of apparent diffusion coefficient value was generated to evaluate the differential diagnostic efficiency of poorly and well/moderately differentiated esophageal carcinoma. Results: No significant difference was observed in apparent diffusion coefficient value between esophageal squamous cell carcinoma and adenocarcinoma and in patients between those with and without lymph node metastases ( P > .05). The differences of apparent diffusion coefficient value were statistically significant between different histologic grades of esophageal carcinoma ( P < .05). The apparent diffusion coefficient value was positively correlated with histologic grade ( rs = 0.802). The apparent diffusion coefficient value ≤1.25 × 10−3 mm2/s as the cutoff value for diagnosis of poorly differentiated esophageal carcinoma with the sensitivity of 84.3%, and the specificity was 94.3%. Conclusions: The performance of apparent diffusion coefficient value was contributing to predict the histologic grade of esophageal carcinoma, which might increase lesions characterization before choosing the best therapeutic alternative. However, they do not correlate with pathological type and the presence of lymph node metastases of esophageal carcinoma.

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PS02.158: DISTRIBUTION OF LYMPH NODE METASTASES IN ESOPHAGEAL CARCINOMA [TIGER STUDY]: A MULTINATIONAL OBSERVATIONAL STUDY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.158 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 166-166

Author(s):

Eliza Hagens ◽

Mark I Van Berge Henegouwen ◽

Suzanne Gisbertz

Keyword(s):

Lymph Node ◽

Adjuvant Therapy ◽

Lymph Nodes ◽

Esophageal Carcinoma ◽

Lymph Node Metastases ◽

Tumor Location ◽

Transthoracic Esophagectomy ◽

Invasion Depth ◽

Tumor Histology ◽

Node Metastases

Abstract Background Lymph node status is an important prognostic parameter in esophageal carcinoma and an independent predictor of survival. Distribution of metastatic lymph nodes may vary with tumor location within the proximal or distal esophagus, tumor histology, tumor invasion depth and neoadjuvant therapy. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. Especially for adenocarcinoma the distribution of lymph node metastases has not yet been described in large series. Aim of the present study is to evaluate the distribution of lymph node metastases in esophageal carcinoma specimens following transthoracic esophagectomy with a 2-or 3-field lymphadenectomy. Methods The TIGER-study is an international observational cohort study with 58 participating centers. All patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival. Results We aim to start inclusion on 1/03/2018 and will present the first results during the congress. Conclusion The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed on the basis of these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics. Disclosure All authors have declared no conflicts of interest.

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Esophageal Carcinoma: Clinical TNM Staging with Endosonography and Computed Tomography

Canadian Journal of Gastroenterology ◽

10.1155/1990/835307 ◽

1990 ◽

Vol 4 (9) ◽

pp. 603-607 ◽

Cited By ~ 2

Author(s):

TL Tio ◽

FCA Den Hartog Jager ◽

PPLO Coene

Keyword(s):

Computed Tomography ◽

Lymph Node ◽

Lymph Nodes ◽

Esophageal Carcinoma ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Diagnostic Value ◽

Tnm Staging ◽

Node Metastases ◽

Diagnostic Modalities

The prognosis of esophageal carcinoma has remained poor despite improvement of diagnostic modalities. Endosonography and computed tomography were performed for preoperative TNM staging (clinical TNM) of esophageal carcinoma. Endosonography was superior to computed tomography for diagnosing early stages and nonresectability of carcinoma. Endosonography was also superior to computed tomography in diagnosing regional lymph node metastases. For diagnosing nonmetastatic lymph nodes, however, computed tomography was superior. Endosonography was superior for diagnosing celiac lymph node metastases but less accurate in detecting liver involvement. Endosonography was accurate for clinical TNM staging of esophageal carcinoma. The possibility of performing cytology and biopsy will further enhance the diagnostic value of endosonography.

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