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Relationship Between the Size of Metastatic Lymph Nodes and Positron Emission Tomographic/Computer Tomographic Findings in Patients with Esophageal Squamous Cell Carcinoma

 Seong Yong Park  ;  Dae Joon Kim  ;  Hee Suk Jung  ;  Mi Jin Yun  ;  Jeong Won Lee  ;  Cheol Keun Park 
 WORLD JOURNAL OF SURGERY, Vol.39(12) : 2948-2954, 2015 
Journal Title
Issue Date
Blood Vessels/pathology ; Carcinoma, Squamous Cell/diagnosis* ; Carcinoma, Squamous Cell/surgery ; Esophageal Neoplasms/diagnosis* ; Esophageal Neoplasms/surgery ; Esophagectomy ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymph Node Excision* ; Lymph Nodes/diagnostic imaging* ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Lymphatic Vessels/pathology ; Male ; Mediastinum ; Middle Aged ; Multimodal Imaging ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Staging ; Positron-Emission Tomography* ; Radiopharmaceuticals ; Risk Factors ; Tomography, X-Ray Computed* ; Tumor Burden
Esophageal Cancer ; Esophageal Squamous Cell Carcinoma ; Metastatic Lymph Node ; Metabolic Tumor Volume ; Esophageal Squamous Cell Carcinoma Patient
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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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Park, Seong Yong(박성용) ORCID logo https://orcid.org/0000-0002-5180-3853
Park, Cheol Keun(박철근) ORCID logo https://orcid.org/0000-0001-7689-0386
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Jeong Won(이정원)
Jung, Hee Suk(정희석)
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