title: Lymphatic micrometastases in patients with early esophageal adenocarcinoma.
abstract: BACKGROUND
  Both endoscopic and surgical treatments are recommended for m3- or sm1-adenocarcinomas of the esophagus, depending on patients' lymph nodal status. Lymphatic dissemination is related to tumor infiltration depth, but varying incidences have been reported in m3- and sm1-adenocarcinomas. The study aim was to investigate whether the presence of occult tumor cells in lymph nodes could explain this variation.
  
  
  METHODS
  Sixty-three node-negative (N0) patients with early esophageal adenocarcinoma (m2/m3/sm1-tumors) were included. Multilevel-sectioning of lymph nodes was performed; sections were stained by means of immunohistochemistry with cytokeratin marker CAM5.2. Two pathologists searched for micrometastases (0.2-2.0  mm) and isolated tumor cells (ITCs, <0.2  mm).
  
  
  RESULTS
  Positive CAM5.2 staining in lymph nodes was not seen in any of the 18 m2-patients. In 2/25 m3-tumors (8.0%) an ITC was found, but no micrometastases. Tumor cells were identified in 4/20 sm1-tumors (20.0%): three micrometastases and one ITC. Median follow-up was 121 months. Two m3-patients (3.2%) died due to disease recurrence, including one patient in whom an ITC was detected.
  
  
  CONCLUSIONS
  Lymphatic migration of tumor cells was found in node-negative m3- and sm1-adenocarcinomas of the esophagus (8.0% and 20.0%, respectively). However, the clinical relevance of these occult tumor cells should become apparent from large series of endoscopically treated patients.
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl
authors.forename: Brechtje A
authors.initials: BA
authors.lastname: Grotenhuis
authors.forename: Mark
authors.initials: M
authors.lastname: van Heijl
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: Katharina
authors.initials: K
authors.lastname: Biermann
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Winand N M
authors.initials: WN
authors.lastname: Dinjens
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000378:metabolism / Q000473:pathology*; D015415:Biomarkers / Q000378:metabolism; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000378:metabolism; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate
chemical_list: D015415:Biomarkers; C400901:CAM 5.2 antigen; D007633:Keratins