Value of Computed Tomography Scan for Detecting Lymph Node Metastasis in Early Esophageal Squamous Cell Carcinoma

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2024 Nov 25

PMID 39586955

Authors

Yunqing Zeng

Yaping Liu

Jinhou Li

Bingcheng Feng

Jiaoyang Lu

Affiliations

Soon will be listed here.

Abstract

Background: The necessity of computed tomography (CT) scan for detecting potential lymph node metastasis (LNM) in early esophageal squamous cell carcinoma (ESCC) before endoscopic and surgical treatments is under debate.

Methods: Patients with histologically proven ESCC limited to the mucosa or submucosa were examined retrospectively. Diagnostic performance of CT for detecting LNM was analyzed by comparing original CT reports with pathology reports. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: A total of 625 patients from three tertiary referral hospitals were included. The rate of pathologically confirmed LNM was 12.5%. Based on original CT reports, the sensitivity, specificity, accuracy, PPV, and NPV of CT to determine LNM in T1 ESCC were 41.0%, 83.2%, 77.9%, 25.8%, and 90.8% respectively. For mucosal cancers (T1a), these parameters were 50.0%, 81.7%, 80.9%, 6.8%, and 98.4%, respectively. For submucosal cancers (T1b), they were 40.0%, 85.0%, 75.0%, 43.0%, and 83.3%, respectively. Additionally, the diagnostic performance of CT for LNM was relatively better for ESCC in the lower esophagus. Pathologically, 69.2% of patients with LNM did not exhibit lymphovascular invasion (LVI), and the sensitivity of CT for recognizing LNM in these patients (33.3%) was lower than those with LVI (58.3%).

Conclusions: Computed tomography can detect nearly half of the LNM cases in early ESCC with high specificity. The performance of CT further improved in LNM cases with LVI. Therefore, we conclude that routine preoperative CT for the assessment of potential LNM risk in patients with early ESCC is necessary.

Citing Articles

ASO Author Reflections: The Necessity of Computed Tomography in Detecting Lymph Node Metastasis in Early Esophageal Squamous Cell Carcinoma.

Zeng Y, Liu Y, Li J, Feng B, Lu J Ann Surg Oncol. 2024; 32(3):1681-1682.

PMID: 39645559 DOI: 10.1245/s10434-024-16670-2.

References

Xie C, Hu Y, Han L, Fu J, Vardhanabhuti V, Yang H . Prediction of Individual Lymph Node Metastatic Status in Esophageal Squamous Cell Carcinoma Using Routine Computed Tomography Imaging: Comparison of Size-Based Measurements and Radiomics-Based Models. Ann Surg Oncol. 2022; 29(13):8117-8126. DOI: 10.1245/s10434-022-12207-7. View

Chen W, Zheng R, Baade P, Zhang S, Zeng H, Bray F . Cancer statistics in China, 2015. CA Cancer J Clin. 2016; 66(2):115-32. DOI: 10.3322/caac.21338. View

Pouw R, Heldoorn N, Alvarez Herrero L, Ten Kate F, Visser M, Busch O . Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases. Gastrointest Endosc. 2011; 73(4):662-8. DOI: 10.1016/j.gie.2010.10.046. View

Min Y, Lee H, Song B, Min B, Kim H, Choi Y . Comparison of endoscopic submucosal dissection and surgery for superficial esophageal squamous cell carcinoma: a propensity score-matched analysis. Gastrointest Endosc. 2018; 88(4):624-633. DOI: 10.1016/j.gie.2018.04.2360. View

Wang Q, Xiang Q, Yu L, Hu T, Chen Y, Wang J . Changes in Tumor-Infiltrating Lymphocytes and Vascular Normalization in Breast Cancer Patients After Neoadjuvant Chemotherapy and Their Correlations With DFS. Front Oncol. 2020; 9:1545. PMC: 6987397. DOI: 10.3389/fonc.2019.01545. View

Kumagai Y, Inoue H, Nagai K, Kawano T, Iwai T . Magnifying endoscopy, stereoscopic microscopy, and the microvascular architecture of superficial esophageal carcinoma. Endoscopy. 2002; 34(5):369-75. DOI: 10.1055/s-2002-25285. View

Hatta W, Koike T, Ogata Y, Kondo Y, Ara N, Uno K . Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society's Intrapapillary Capillary Loop Classification. Diagnostics (Basel). 2021; 11(11). PMC: 8625194. DOI: 10.3390/diagnostics11111941. View

Chen H, Wang X, Shao S, Zhang J, Tan X, Chen W . Value of EUS in determining infiltration depth of early carcinoma and associated precancerous lesions in the upper gastrointestinal tract. Endosc Ultrasound. 2022; 11(6):503-510. PMC: 9921983. DOI: 10.4103/EUS-D-21-00218. View

Tirumani H, Rosenthal M, Tirumani S, Shinagare A, Krajewski K, Ramaiya N . Esophageal Carcinoma: Current Concepts in the Role of Imaging in Staging and Management. Can Assoc Radiol J. 2015; 66(2):130-9. DOI: 10.1016/j.carj.2014.08.006. View

10.

Sancheti M, Fernandez F . Management of T2 esophageal cancer. Surg Clin North Am. 2012; 92(5):1169-78. DOI: 10.1016/j.suc.2012.07.003. View

11.

Shi H, Ma S, Zhao P, Jiang J, Cheng Y, Zhao J . Endoscopic ultrasonography for preoperative staging of esophageal carcinoma. Scand J Gastroenterol. 2017; 52(10):1052-1056. DOI: 10.1080/00365521.2017.1339829. View

12.

Zhao B, Zhu H, Li X, Shi Y, Cao K, Sun Y . Predicting Lymph Node Metastasis Using Computed Tomography Radiomics Analysis in Patients With Resectable Esophageal Squamous Cell Carcinoma. J Comput Assist Tomogr. 2021; 45(2):323-329. DOI: 10.1097/RCT.0000000000001125. View

13.

Geng X, Zhang Y, Li Y, Cai Y, Liu J, Geng T . Radiomics-clinical nomogram for preoperative lymph node metastasis prediction in esophageal carcinoma. Br J Radiol. 2024; 97(1155):652-659. PMC: 11027331. DOI: 10.1093/bjr/tqae009. View

14.

Pimentel-Nunes P, Libanio D, Bastiaansen B, Bhandari P, Bisschops R, Bourke M . Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy. 2022; 54(6):591-622. DOI: 10.1055/a-1811-7025. View

15.

van Vliet E, Heijenbrok-Kal M, Hunink M, Kuipers E, Siersema P . Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer. 2008; 98(3):547-57. PMC: 2243147. DOI: 10.1038/sj.bjc.6604200. View

16.

Fujikawa H, Yoshikawa T, Hasegawa S, Hayashi T, Aoyama T, Ogata T . Diagnostic value of computed tomography for staging of clinical T1 gastric cancer. Ann Surg Oncol. 2014; 21(9):3002-7. DOI: 10.1245/s10434-014-3667-9. View

17.

Yu J, Ouyang W, Li C, Shen J, Xu Y, Zhang J . Mapping patterns of metastatic lymph nodes for postoperative radiotherapy in thoracic esophageal squamous cell carcinoma: a recommendation for clinical target volume definition. BMC Cancer. 2019; 19(1):927. PMC: 6749673. DOI: 10.1186/s12885-019-6065-7. View

18.

Betancourt Cuellar S, Sabloff B, Carter B, Benveniste M, Correa A, Maru D . Early clinical esophageal adenocarcinoma (cT1): Utility of CT in regional nodal metastasis detection and can the clinical accuracy be improved?. Eur J Radiol. 2017; 88:56-60. DOI: 10.1016/j.ejrad.2017.01.001. View

19.

Yan Z, Xu X, Lu J, You Y, Xu J, Xu T . Development and validation of a nomogram for prediction of cervical lymph node metastasis in middle and lower thoracic esophageal squamous cell carcinoma. BMC Gastroenterol. 2022; 22(1):163. PMC: 8978436. DOI: 10.1186/s12876-022-02243-8. View

20.

Mirza A, Galloway S . Laparoscopy, computerised tomography and fluorodeoxyglucose positron emission tomography in the management of gastric and gastro-oesophageal junction cancers. Surg Endosc. 2015; 30(7):2690-6. DOI: 10.1007/s00464-015-4590-2. View