Abstract
Objective: The purpose of this study was to detect lymphatic drainage into the superior mediastinum and neck in thoracic esophageal cancer patients using ferumoxides-enhanced magnetic resonance imaging (MRI), and to have this information assist in determining the appropriate extent of lymphadenectomy. Methods: Nine male patients with T2–T3 mid- and lower-thoracic esophageal cancer with lymph node metastasis were examined. The day before surgery, ferumoxides was endoscopically injected into the submucosal layer of the peritumoral lesion. Thereafter, lymph nodes in the superior mediastinum and neck, which were shown to be ferumoxides-enhanced on MRI, were harvested and evaluated; magnetic force from all harvested lymph nodes was measured ex vivo. Results: MRI of the superior mediastinum and neck revealed l(median) ferumoxides-enhanced lymph nodes in eight (89%) patients, and there was laterality in the lymphatic mapping in both areas. Of the 15 lymph nodes into which drainage was detected by enhanced MRI, 12 (80%) were magnetite-positive. In six patients (67%), magnetic resonance enhanced lymph nodes corresponded completely with the ex vivo magnetite examination, and in 3 patients (33%) there was partial agreement In 3 (60%) of the 5 patients that showed paratracheal and/or supraclavicular lymph node metastases, all of the affected nodes were detected by MRI; in one patient some of the affected nodes were detected. Conclusion: Ferumoxides-enhanced MRI is useful for visualizing lymphatic drainage to the superior mediastinum and neck in thoracic esophageal cancer. It is an adequate procedure to form an estimate on the appropriate extent of lymphadenectomy.
Similar content being viewed by others
References
Shimada Y, Imamura M, Watanabe G, Uchida S, Harada H, Makino T, et al. Prognostic factors of oesophageal squamous cell carcinoma from the perspective of molecular biology. Br J Cancer 1999; 80: 1281–8.
Kawahara K, Maekawa T, Okabayashi K, Shiraishi T, Yoshinaga Y, Yoneda S, et al. The number of lymph node metastases influences survival in esophageal cancer. J Surg Oncol 1998; 67: 160–3.
Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg 2001; 234: 581–7.
Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 1995; 222: 654–62.
Nishihira T, Hirayama K, Mori S. A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 1998; 175: 47–51.
Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 1994; 220: 364–73.
Karl RC, Schreiber R, Boulware D, Baker S, Coppola D. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 2000; 231: 635–43.
Goldmine M, Maddern G, Le Prise E, Meunier B, Campion JP, Launois B. Oesophagectomy by a transhiatal approach or thoracotomy: A prospective randomized trial. Br J Surg 1993; 80: 367–70.
Abo S, Kitamura M, Hashimoto M, Izumi K, Minamiya Y, Shikama T, et al. Analysis of results of surgery performed over a 20-year period on 500 patients with cancer of the thoracic esophagus. Surg Today 1996; 26: 77–82.
Motoyama S, Saito R, Kitamura M, Ogawa J. Outcomes of active operation during intensive follow-up for second primary malignancy after esophagectomy for thoracic squamous cell esophageal carcinoma. J Am Coll Surg 2003; 197: 914–20.
Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am 2000; 80: 1799–809.
Kitagawa Y, Ohgami M, Fujii H, Mukai M, Kubota T, Ando N, et al. Laparoscopic detection of sentinel lymph nodes in gastrointestinal cancer: A novel and minimally invasive approach. Ann Surg Oncol 2001; 8: 86S-9S.
Imano H, Saito R, Katayose Y, Motoyama S, Nakamura M, Okuyama M, et al. A Novel method of sentinel lymph node mapping using magnetite in patients with thoracic esophageal cancer, Akita J Med 2003; 30: 91–8.
Nakagawa T, Minamiya Y, Katayose Y, Saito H, Taguchi K, Imano H, et al. A novel method for sentinel lymph node mapping using magnetite in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2003; 126: 563–7.
Murakami G, Abe M, Abe T. Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera. Jpn J Thorac Cardiovasc Surg 2002; 50: 93–103.
Matsubara T, Ueda M, Kaisaki S, Kuroda J, Uchida C, Kokudo N, et al. Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer 2000; 89: 1869–73.
Matsubara T, Ueda M, Yanagida O, Nakajima T, Nishi M. How extensive should lymph node dissection be for cancer of the thoracic esophagus? J Thorac Cardiovasc Surg 1994; 107: 1073–8.
Saini S, Stark DD, Hahn PF, Wittenberg J, Brady TJ, Ferrucci JT Jr. Ferrite particles: A superparamagnetic MR contrast agent for the reticuloendothelial system. Radiology 1987; 162: 211–6.
Author information
Authors and Affiliations
Additional information
Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Symposium, Tokyo, November 19–21, 2003.
Rights and permissions
About this article
Cite this article
Imano, H., Motoyama, S., Saito, R. et al. Superior mediastinal and neck lymphatic mapping in mid- and lower-thoracic esophageal cancer as defined by ferumoxides-enhanced magnetic resonance imaging. Jpn J Thorac Caridovasc Surg 52, 445–450 (2004). https://doi.org/10.1007/s11748-004-0137-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-004-0137-5