title: Tumor cell dissociation score highly correlates with lymph node metastasis in superficial esophageal carcinoma.
abstract: BACKGROUND
  It is still not clear which parameters are important for predicting the metastatic potential of superficial esophageal squamous cell carcinoma (SESCC). The purpose of the present paper was thus to investigate tumor cell dissociation (TCD) in SESCC as a predictive factor of lymph node metastasis.
  
  
  METHODS
  Thirty-three SESCC were classified into four groups based on the depth of tumor invasion. Carcinomas not invading as far as the muscularis mucosa were classified as group A; carcinomas invading to the muscularis mucosa or less than one-third of the upper submucosa were classified as group B; those invading to the middle layer of the submucosa were classified as group C; and those invading one-third of the lower submucosa were classified as group D. The TCD score was calculated by dividing the length of the TCD region by the maximal longitudinal length of the area of invasion into or beyond the lamina propria, and multiplying by 100. E-cadherin expression of the carcinomas was investigated in the TCD area and the successive area of mucosal invasive carcinoma (SAM).
  
  
  RESULTS
  The incidence of lymph node metastasis was 0% in group A, 10% in group B, 36.4% in group C and 57.1% in group D. The mean TCD scores (+/-SEM) of SESCC with lymph node metastasis were higher than that without (85.3 +/- 5.7, 16.3 +/- 3.9, respectively; P < 0.001). In group C, the TCD score of cases with lymph node metastases was higher than in those without lymph node metastasis (P < 0.001). E-cadherin expression was significantly reduced in the area of TCD compared with the SAM located over the TCD area (P < 0.001).
  
  
  CONCLUSIONS
  The TCD score is an important predictive marker for lymph node metastasis in SESCC. Clinical evaluation of TCD scores in endoscopic mucosal resection (EMR) specimens would enable accurate prediction of lymph node metastasis and extend the indication of EMR treatment for SESCC.
authors.affiliation: Department of Surgical and Molecular Pathology, Dokkyo University School of Medicine, Tochigi, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Chibana
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Fujii
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Ichikawa
authors.forename: Mikio
authors.initials: M
authors.lastname: Fujita
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tomita
authors.forename: Johji
authors.initials: J
authors.lastname: Imura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kawamata
authors.forename: Akira
authors.initials: A
authors.lastname: Terano
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujimori
mesh_terms: D000368:Aged; D015820:Cadherins / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000145:classification / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000145:classification / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests
chemical_list: D015820:Cadherins