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Optimal criteria for predicting lymph node metastasis in esophageal squamous cell carcinoma by anatomical location using preoperative computed tomography: a retrospective cohort study

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Abstract

Purpose

Predicting lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) is critical for selecting appropriate treatments despite the low accuracy of computed tomography (CT) for detecting LNM. Variation in potential nodal sizes among locations or patients’ clinicopathological background factors may impact the diagnostic quality. This study explored the optimal criteria and diagnostic ability of CT by location.

Methods

We retrospectively reviewed preoperative CT scans of 229 patients undergoing curative esophagectomy. We classified nodal stations into six groups: Cervical (C), Right-upper mediastinal (UR), Left-upper mediastinal (UL), Middle mediastinal (M), Lower mediastinal (L), and Abdominal (A). We then measured the short-axial diameter (SAD) of the largest lymph node in each area. We used receiver operating characteristics analyses to evaluate the CT diagnostic ability and determined the cut-off values for the SAD in all groups.

Results

Optimal cut-offs were 6.5 mm (M), 6 mm (C, L, and A), and 5 mm (UR and UL). Diagnostic abilities differed among locations, and UR had the highest sensitivity. A multivariate analysis showed poor differentiation to be an independent risk factor for a false-negative diagnosis (p = 0.044).

Conclusions

Optimal criteria and diagnostic abilities for predicting LNM in ESCC varied among locations, and poor differentiation might contribute to failure to detect LNM.

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Abbreviations

ESCC:

Esophageal squamous cell cancer

LNM:

Lymph node metastasis

CT:

Computed tomography

NAC:

Neoadjuvant chemotherapy

LNA:

Lymph node area

SAD:

Short-axis diameter

TME:

Transmediastinal esophagectomy

TTE:

Transthoracic esophagectomy

ROC:

Receiver operating characteristics

AUC:

Area under the curve

PPV:

Positive predictive value

Y statistic:

Youden’s J statistic

pdESCC:

Poorly differentiated esophageal squamous cell cancer

EUS:

Endoscopic ultrasound

FDG-PET:

8F-fluorodeoxyglucose positron emission tomography

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Acknowledgements

We thank the past and present members of our department for collecting the data used for this analysis from the early period of the study.

Funding

This research received no specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Shinichiro Shiomi, Shoh Yajima, Shuntaro Yoshimura, Masayuki Urabe, Motonari Ri, Yasuhiro Okumura, Koichi Yagi, Susumu Aikou, Sachiyo Nomura & Yasuyuki Seto

  2. Department of Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-0071, Japan

    Susumu Aikou

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  1. Shinichiro Shiomi
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Correspondence to Shoh Yajima.

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Sachiyo Nomura is the recipient of a research grant from JCR Pharmaceuticals Co., Ltd. The other authors have no potential conflicts of interest to disclose.

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Shiomi, S., Yajima, S., Yoshimura, S. et al. Optimal criteria for predicting lymph node metastasis in esophageal squamous cell carcinoma by anatomical location using preoperative computed tomography: a retrospective cohort study. Surg Today 52, 1185–1193 (2022). https://doi.org/10.1007/s00595-022-02460-4

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  • DOI: https://doi.org/10.1007/s00595-022-02460-4

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