摘要
Endoscopic techniques are being developed for the local treatment of early stage esophageal cancer. However, such therapy is not appropriate for patients with lymph node metastasis. The aim of this study was to analyze the histopathologic features of high-grade dysplasia and early stage adenocarcinoma and to relate these to lymph node involvement. Pathology reports were reviewed for all 367 pat ients who underwent subtotal esophagectomy for high grade dysplasia or adenocar cinoma of the esophagus or the gastroesophageal junction between January 1993 and December 2001. Patients with histopathologically confirmed high-grade dysplasia or T1 carcinoma were included (n = 77). Pre operative EUS results were asses sed. All lesions were histopathologically subdivided in 6 different stages (muco sal 1-3 and submucosal 1-3). EUS staged 61 patients as N0. EUS correctly predi cted the absence of positive lymph nodes in 57 (93%) of these patients. Histopa thologically, m1, m2, m3, and sm1 cancers never had lymph node metastases, whereas 3 of 13 sm2 tumors (23%) and 9 of 13 sm3 tumors (69%) had lymph node involvement. Lymphangio invasion was present exclusi vely in sm2 and sm3 cancers. Factors that predicted the presence of lymph node metastasis were the following: tumor diameter greater than 3 cm, infiltration of malignancy beyond sm1, poor differentiation grade, and lymphangio invasion, although only infiltration beyond sm1 remained significant in the definitive multiva riate analysis. EUS and the histopathologic features of high-grade dysplasia an dearly stage adenocarcinoma of the esophagus or the gastroesophageal junctionc an predict the presence of lymph node involvement. These data can be used to ide ntify patients for whom local endoscopic treatment may be appropriate.
Endoscopic techniques are being developed for the local treatment of early stage esophageal cancer. However, such therapy is not appropriate for patients with lymph node metastasis. The aim of this study was to analyze the histopathologic features of high-grade dysplasia and early stage adenocarcinoma and to relate these to lymph node involvement. Pathology reports were reviewed for all 367 pat ients who underwent subtotal esophagectomy for high grade dysplasia or adenocar cinoma of the esophagus or the gastroesophageal junction between January 1993 and December 2001. Patients with histopathologically confirmed high-grade dysplasia or T1 carcinoma were included (n = 77). Pre operative EUS results were asses sed. All lesions were histopathologically subdivided in 6 different stages (muco sal 1-3 and submucosal 1-3). EUS staged 61 patients as N0. EUS correctly predi cted the absence of positive lymph nodes in 57 (93%) of these patients. Histopa thologically, m1, m2, m3, and sm1 cancers never had lymph node metastases, whereas 3 of 13 sm2 tumors (23%) and 9 of 13 sm3 tumors (69%) had lymph node involvement. Lymphangio invasion was present exclusi vely in sm2 and sm3 cancers. Factors that predicted the presence of lymph node metastasis were the following: tumor diameter greater than 3 cm, infiltration of malignancy beyond sm1, poor differentiation grade, and lymphangio invasion, although only infiltration beyond sm1 remained significant in the definitive multiva riate analysis. EUS and the histopathologic features of high-grade dysplasia an dearly stage adenocarcinoma of the esophagus or the gastroesophageal junctionc an predict the presence of lymph node involvement. These data can be used to ide ntify patients for whom local endoscopic treatment may be appropriate.
