Learning objectives
The purpose of this exposition is to review the esophageal lymph nodal drainage and its key role in esophageal cancer staging by the widely used tumor node metastasis staging system (TNM).
Background
Esophageal carcinoma (EC) is the eight most common cancer and the sixth most common cause of cancer-related deaths worldwide. Despite improvements in diagnosis and treatments of EC,
overall 5-year survival rate is still very low (–40%)
Lymph node status has been recognized as one of the most important independent factor that influences the prognosis of EC,
especially the number or ratio of involved nodes - an increasing number of metastatic lymph nodes is associated with a poorer prognosis.
Therefore,
lymphadenectomy’s technique has been recognized as...
Imaging findings OR procedure details
8th edition TNM clinical staging - N-category
A multimodal approach to staging,
with the combined use of PET–CT and EUS imaging,
allows for a more detailed and accurate assessment of lymph node involvement in patients with esophageal cancer as compared to CT alone.
EUS is used to evaluate size,
shape,
border,
and internal echocardiographic characteristics of regional lymph nodes.
Larger,
more rounded,
well demarcated hypoechoic lymph nodes are most likely to contain metastasis.
In patients with a 60% prevalence of pN+,
using EUS criteria of...
Conclusion
Lymph node metastasis is a key factor that affects both surgical treatment and prognosis in patients with EC.
Lymphatic channels within the esophagus are very complex,
resulting in variable lymphatic spread and skip metastases in EC.Thus,
reasonable lymphadenectomy becomes very important,
offering a better treatment outcome and accurate staging.
CT,
endoscopic ultrasound and PET-CT are important tools for staging of patients with EC.
Radiologists shouldbe aware of the TNM staging system in order to provide significant and accurate information about tumorlocoregional extent to ensure the...
References
Chandna,
Parveen & M.
B.,
Siddesh & M.
U.,
Jeevika & Kumar T.
Kochar,
Praveen.
(2017).
CT imaging and staging of carcinoma oesophagus.
International Journal of Research in Medical Sciences.
5.
2021.
New TNM Staging System for Esophageal Cancer: What Chest Radiologists Need to KnowSu Jin Hong,Tae Jung Kim,Kyung Bum Nam,In Sun Lee,Hee Chul Yang,Sukki Cho,Kwhanmien Kim,Sanghoon Jheon,
andKyung Won Lee
RadioGraphics201434:6,1722-1740
Multimodality Assessment of Esophageal Cancer: Preoperative Staging and Monitoring of Response to TherapyTae Jung Kim,Hyae Young Kim,Kyung Won Lee,
andMoon Soo Kim
RadioGraphics200929:2,403-421...