Imaging of the Cervical and Abdominal Lymph Nodes in a Combined Treatment of Squamous Cell Oesophageal Carcinoma

• Authors: Grzegorz Ćwik , Andrzej Dąbrowski , Tomasz Skoczylas , Grzegorz Wallner
• Languages of publication: EN

Abstracts

EN

The presence of lymph node metastases in esophageal cancer is one of the most principle prognostic indicators.The aim of the study was the assessment of cervical and abdominal lymph nodes (N/pN) by ultrasound (US) examination in patients with squamous cell carcinoma of the thoracic esophagus referred to esophagectomy.Material and methods. The analyzed study population consisted of 110 patients who underwent a combined-modality treatment (neoadjuvant chemotherapy - 74 patients or chemoradiotherapy - 36 patients). The results of US lymph node assessment were compared to the results of histopathological evaluation of lymph nodes harvested during surgery and diagnostic value of cervical and abdominal US in terms of sensitivity, specificity, positive and negative predictive value were determined.Results. The complete metastatic regression was shown by US in 14.3-22.2% of patients depending on the node location and mode of neoadjuwant treatment. There was no significant difference in the assessment of lymph nodes between chemotherapy and chemoradiotherapy patients.Conclusions. US investigation is a method recommended for the assessment of metastatic lymph nodes in squamous cell oesophageal carcinoma, especially - for cervical nodes, where its specificity amounted to 96% and sensitivity - 100%. When positive nodes are suggested by US of the neck esophagectomy should be combined with 3-field lymphadenectomy.

Keywords

EN

Squamous cell oesophageal carcinoma; lymph nodes metastases; US of cervical lymph nodes

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2011
• Volume: 83
• Issue: 2
• Pages: 95-101

Dates

published

1 - 2 - 2011

online

30 - 3 - 2011

Contributors

author

Grzegorz Ćwik

• 2 Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract, Medical University in Lublin

author

Andrzej Dąbrowski

• 2 Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract, Medical University in Lublin

author

Tomasz Skoczylas

• 2 Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract, Medical University in Lublin

author

Grzegorz Wallner

• 2 Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract, Medical University in Lublin

References

• Igaki H, Kato H, Tachimori Y et al.: Cervical lymph node matastasis in patients with submucosal carcinoma of the thoracic esophagus. J Surg Oncol. 2000; 75: 37-41.[Crossref]
• Law S, Wong J: Two-field dissection is enough for esophageal cancer. Dis Esophagu. 2001; 14: 98-103.[Crossref]
• Siewert JR, Stein HJ: Lymph-node dissection in squamous cell esophageal cancer - who benefits? Langenbecks Arch Surg 1999; 384: 141-48.
• Misiuna P, Furman M, Kopacz A et al.: Combined modality treatment of oesophageal carcinoma. Skojarzone leczenie raka przelyku. W: Wybrane Zagadnienia z Chirurgii (Wiechowski S. red) Fund. Pol. Przegl. Chir. Warszawa 1995; 3: 178-181.
• Tytgat G: Esophageal cancer. Opinion in Gastroenterology 1994; 10: 455-64.
• Giovannini M, Seitz J, Thomas P et al.: Endoscopic ultrasonography for assesment of the response to combined radiation therapy and chemotherapy in patients with esophageal cancer. Endoscopy 1997; 29: 4-9.[Crossref]
• Medical Research Council Oesophageal Cancer Working Party. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet 2002; 359: 1727-34.
• Ilson D, Kelsen DP: Combined modality therapy in the treatment of esophageal cancer. Semin Oncol 1994; 21: 493-507.[PubMed]
• Ruol A and panel of experts: Multimodality treatment for non-metastatic cancer of the thoracic esophagus. Results of a Consensus Conference held at the VI-th World Congress of the International Society for Diseases of the Esophagus. Dis Esoph 1996; 9 (suppl 1): 39-55.
• Matsubara T, Ueda M, Abe T et al.: Unique distribution of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus. Br J Surg 2000; 85: 669-73.
• Kato H, Tachimori Y, Mizobuchi S et al.: Cervical, mediastinal lymph node dissection (3-field dissection) for superficial carcinoma of the thoracic esophagus. Cancer 1993; 72: 2879-82.
• Natsugoe S, Yoshinaka H, Morinaga T et al.: Ultrasonographic detection of lymph-node metastasis in superficial carcinoma of the esophagus. Endoscopy 1996; 28: 674-79.[Crossref][PubMed]
• Okuma T, Kaneko H, Yoshioka M et al.: Prognosis in esophageal carcinoma with cervical lymph node metastases. Surgery 1993; 114: 513-18.
• Akiyama H, Tsurumaru M, Kawamura T et al.: Principles of surgical treatment for carcinoma of the esophagus. Ann Surg 1981; 194: 438-47.
• Tabira Y, Yasunaga M, Tanaka M et al.: Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma. J Am College Surg 2000; 191: 232-37.
• Altorki NK, Skinner DB: Occult cervical nodal metastasis on esophageal cancer: preliminary results of three-field lymphadenectomy. J Thorac Cardiovasc Surg 1997; 113: 540-44.
• Asakura S, Nabeya K, Hanaoka T et al.: The effectivenes of ultrasonography in diagnosis of cervical lymph node metastasis in preoperative esophageal cancer. Springer-Verlag Tokyo 1993: 580-91.
• Fujita H, Kakegawa T, Yamana H et al.: Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who under-went three-field dissection. World J Surg 1994; 18: 266-72.[Crossref]
• Tachimori Y, Kato H, Watanabe H et al.: Neck ultrasonography for thoracic esophageal carcinoma. Ann Thorac Surg 1994; 57: 1180-83.[PubMed][Crossref]
• van Overhagen H, Lameris JS, Berger MY et al.: Supraclavicular lymph node metastases in carcinoma of the esophagus and gastro-esophageal junction: Assesment with Ct, US, and US-guided fine-needle aspiration biopsy. Radiology 1991; 179: 155-58.
• Griffith JF, Chan AC, Ahuja AT et al.: Neck ultrasound in staging squamous oesophageal carcinoma - a high yield technique. Clin Radiol 2000; 55: 696-701.
• Hajek P, Salomonowitz E, Turk R et al.: Lymph nodes of the neck: Evaluation with US. Radiology 1986; 158: 739-42.
• Yusa H, Yoshida H, Ueno E: Ultrasonographic criteria for diagnosis of cervical lymph node metastasis of squamous cell carcinoma. J Oral Maxillofacial Surg 1999; 57: 41-48.
• van den Brekel MW, Stel HV, Castelijns JA et al.: Cervical lymph node metastasis: Assesment of radiologic criteria. Radiology 1990; 177: 379-84.
• Zajkowski P, Białek EJ, Jakubowski W: Ultrasonograficzna diagnostyka różnicowa powiększonych węzłów chłonnych szyi. Ultrasonografia 2000; 4: 57-63.
• Ćwik G, Dąbrowski A, Ciechański A et al.: Rak przełyku - ocena zmian przerzutowych do węzłów chłonnych szyi oraz jamy brzusznej w badaniu USG. Pol Przegl Chir 2002; 74(2): 150-59.
• Metzger R, Bollschweller E, Drebber U et al.: Neoadjuvant chemoradiotherapy for esophageal cancer: Impact on extracapsular lymph node involvement. World J Gastroenterol 2010; 16: 1986-92.[PubMed][WoS][Crossref]
• Wilson M, Rosato EL, Chojnacki KA et al.: Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res 2008; 146(1): 11-15.
• Herrera LJ: Extent of lymphadenectomy in esophageal cancer: How many lymph nodes is enough? Ann Surg Oncol 2010; 17: 676-78.[PubMed][Crossref][WoS]
• Lv J, Cao XF, Zhu B et al.: Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. World J Gastroenterol 2009; 15(39): 4962-68.[Crossref][PubMed]
• Schneider PM, Baldus SE, Metzger RM et al.: Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer. Ann Surg 2005; 242: 684-92.

Identifiers

DOI

10.2478/v10035-011-0015-7