IngentaConnect Detection of Occult Lymph Node Metastases in Esophageal Cancer by...

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.

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

Detection of Occult Lymph Node Metastases in Esophageal Cancer by Minimally Invasive Staging Combined with Molecular Diagnostic Techniques