Authors: Kassis, Edmund S.¹; Nguyen, Ninh¹; Shriver, Sharon P.²; Siegfried, Jill M.²; Schauer, Philip R.¹; Luketich, James D.³

Source: JSLS, Journal of the Society of Laparoendoscopic Surgeons, Volume 2, Number 4, October-December 1998 , pp. 331-336(6)

Publisher: Society of Laparoendoscopic Surgeons

Abstract:

Background and Objectives: Lymph node metastases are the most important prognostic factor in patients with esophageal cancer. Histologic examination misses micrometastases in up to 20% of lymph nodes evaluated. In addition, non-invasive imaging modalities are not sensitive enough to detect small lymph nodes metastases. The objective of this study was to investigate the use of reverse transcriptase-polymerase chain reaction (RT-PCR) of messenger RNA (mRNA) for carcinoembryonic antigen (CEA) to increase the detection of micrometastases in lymph nodes from patients with esophageal cancer.

Methods: RT-PCR of CEA mRNA was performed in lymph nodes from patients with malignant and benign esophageal disease. Each specimen was examined histopathologically and by RT-PCR and the results were compared.

Results: Metastases were present in 29 of 60 (48%) lymph nodes sample by minimally invasive staging from 13 patients with esophageal cancer when examined histopathologically. RT-PCR identified nodal metastases in 46 of these 60 (77%) samples. RT-PCR detected CEA mRNA in all 29 histologically positive samples and in 17 histologically negative lymph nodes. All lymph nodes from patients with benign disease (n=15) were negative both histopathologically and by RT-PCR. The stage of two patients was reclassified based on the RT-PCR results, which identified lymph node spread undetected histopathologically. Both of these patients developed recurrent disease after resection of the primary tumor.

Conclusions: RT-PCR is more sensitive than histologic examination in the detection of lymph node metastases in esophageal cancer and can lead to diagnosis of a more advanced stage in some patients. The combination of minimally invasive surgical techniques in combination with new molecular diagnostic techniques may improve our ability to stage cancer patients.

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Keywords: LAPAROSCOPY; ESOPHAGEAL CANCER; LYMPH NODE METASTASIS

Document Type: Research article

Affiliations: 1: Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 2: Departments of Pharmacology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 3: Head, Section of Thoracic Surgery, Suite 300 Kaufmann Bldg., 3471 Fifth Ave., Pittsburgh, PA 15213, USA

Publication date: 1998-10-01

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