Seong Yong Park1, Dae Joon Kim2, Hee Suk Jung3, Mi Jin Yun4, Jeong Won Lee5, Cheol Keun Park6. 1. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. psy1117@hanmail.net. 2. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. kdjcool@yuhs.ac. 3. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. hsjung80@yuhs.ac. 4. Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. yunmijin@yuhs.ac. 5. Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. jwlee223@ish.or.kr. 6. Department of Pathology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. pck0111@yuhs.ac.
Abstract
BACKGROUND: We measured the sizes of metastatic lymph nodes and the relationships thereof by (18)F-fluorodeoxyglucose positron emission tomography/computer tomography (PET/CT). We identified risk factors for nodal upstaging in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Eighty-five patients with ESCC who underwent esophagectomy with extensive mediastinal lymphadenectomy were assessed. Two radiologists blinded to pathology data reviewed PET/CT scans, evaluating both primary tumors and lymph node involvement. A pathologist examined all metastatic lymph nodes in terms of maximal diameter (LNmax), the size of the metastatic focus (Fmax), and the metastasis occupation ratio (MOR = Fmax/LNmax). RESULTS: The maximal tumor length averaged 2.9 ± 0.2 cm and the mean SUVmax of the primary lesion 5.3 ± 0.5. On PET/CT scans, 26 (30.6 %) patients exhibited nodal metastasis and 59 (69.4 %) did not. Pathology grades of pN0, pN1, pN2, and pN3 were assigned to 45 (52.9 %), 24 (28.2 %), 13 (15.3 %), and 3 (3.5 %) patients, respectively. Nodal upstaging was evident in 29 (34.1 %) cases. In 123 metastatic nodes of 4212 nodes dissected, the LNmax was 6.60 ± 0.39 mm, the Fmax 4.47 ± 0.35 mm, and the MOR 0.68 ± 0.03. Of 123 nodes, 85 (69.1 %) were retrieved from PET-negative stations, and the LNmax and Fmax values of these nodes were 5.88 ± 0.42 and 3.75 ± 0.31 mm, respectively. Upon multivariate analysis, tumor length (OR 1.666, p = 0.019) and lymphovascular invasion (OR 41.038, p < 0.001) were risk factors for nodal upstaging. CONCLUSION: A significant proportion of nodal metastases were too small to detect via PET/CT imaging. Therefore, meticulous lymph node dissection might be helpful in ESCC patients.
BACKGROUND: We measured the sizes of metastatic lymph nodes and the relationships thereof by (18)F-fluorodeoxyglucose positron emission tomography/computer tomography (PET/CT). We identified risk factors for nodal upstaging in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Eighty-five patients with ESCC who underwent esophagectomy with extensive mediastinal lymphadenectomy were assessed. Two radiologists blinded to pathology data reviewed PET/CT scans, evaluating both primary tumors and lymph node involvement. A pathologist examined all metastatic lymph nodes in terms of maximal diameter (LNmax), the size of the metastatic focus (Fmax), and the metastasis occupation ratio (MOR = Fmax/LNmax). RESULTS: The maximal tumor length averaged 2.9 ± 0.2 cm and the mean SUVmax of the primary lesion 5.3 ± 0.5. On PET/CT scans, 26 (30.6 %) patients exhibited nodal metastasis and 59 (69.4 %) did not. Pathology grades of pN0, pN1, pN2, and pN3 were assigned to 45 (52.9 %), 24 (28.2 %), 13 (15.3 %), and 3 (3.5 %) patients, respectively. Nodal upstaging was evident in 29 (34.1 %) cases. In 123 metastatic nodes of 4212 nodes dissected, the LNmax was 6.60 ± 0.39 mm, the Fmax 4.47 ± 0.35 mm, and the MOR 0.68 ± 0.03. Of 123 nodes, 85 (69.1 %) were retrieved from PET-negative stations, and the LNmax and Fmax values of these nodes were 5.88 ± 0.42 and 3.75 ± 0.31 mm, respectively. Upon multivariate analysis, tumor length (OR 1.666, p = 0.019) and lymphovascular invasion (OR 41.038, p < 0.001) were risk factors for nodal upstaging. CONCLUSION: A significant proportion of nodal metastases were too small to detect via PET/CT imaging. Therefore, meticulous lymph node dissection might be helpful in ESCC patients.
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